Christmas Around the World

Christmas Day finds my family on three different continents, what's new? We're in Barcelona, the sun is shining and the sky bright blue over the Mediterranean Sea. Our Christmas dinner will likely consist of tapas instead of turkey. My older sister is in the midst of an Australian summer while the younger one is on a local boat somewhere on the Amazon between Pucalpa and Iquitos in Peru, a few cows are penned on the boat deck and apparently there was potential for one of the chickens to turn into Christmas Eve dinner! Mom and dad are staying in Calgary this Christmas, celebrating with old friends while my in-laws are having a feast in a brown and snowless Manitoba...what a family it is!

Of course, Christmas in much of the world is very different than the shimmering lights, Christmas markets and designer boots we find ourselves surrounded by here in Spain. I love the public health messaging campaign below about the 'festive season'. The gift of health for Christmas is priceless but as 'cheap' as two doses of antimalarials for some!



Wishing you all the best of Christmases, may you know hope and peace, and share some of it around.

Tanzanian Nostalgia

I recently went on a rather nostalgic trip to Tanzania to climb Kilimanjaro (an epic tale told elsewhere). Let me be clear, it wasn’t nostalgic because I’d climbed the mountain so many times before! The truth is, I really like Uganda. It’s a country with a dark and violent past where (for the most part) people have chosen reconciliation over judgment and much about the nation and its people fascinate me. But I LOVE Tanzania, perhaps because I speak the language, I can interact on a different level, joking and teasing. Undoubtedly it is because I spend a very formative year of my life there. Immersed in Tanzanian food, culture, language and families. I will forever think their elephants are larger, their hearts are bigger and their language more beautiful. There’s no questions I’ve left a chunk of my heart there. The nuances of Ugandan work culture and language are to some extent wasted on me. Tanzania was my first African love, I can’t help it!

I miss Tz.

Cervical Cancer History

As we wind our way deeper into Kisenyi II past the pungent aroma of fermenting millet, down a steep alley, through a door that opens onto a dirt courtyard of children playing and women washing clothes, around the corner of a block of latrines you can see how a child could get washed away in a downpour. We edge along narrow ledges between houses, the drop-off off to deep open sewers inches from my toes. I duck my head to follow Veronica into a house, a sheer piece of cloth is the door. We are welcomed and a colouful woven mat is layed on the floor where I sit, legs bend beneath me next to Hadija, a wide-eyed 2-year old chewing on her breakfast chapatti. The morning sun glows through the curtain as Veronica explains what we're doing and asks if the woman would like to participate. She's keen to get tested only after she is reassured that she won't have to 'open her legs for an exam like they do at the hospital' unless the test is positive.

Although I am obviously deeply invested in the project and passionate about working towards preventing women dying of something so incredibly preventable it still boggles my mind that women are so open to collecting their own samples and being screened for HPV. On our first day of testing, one of the teachers at the primary school heard we were testing for cervical cancer and ran over to find us during recess so she could get tested. They take the swabs, go behind a curtain or to the latrine, and come back with the specimens for the research assistants to label then ferry to the lab for analysis. To be honest, if someone showed up at my door with a cooler full of swabs and asked if I wanted 'do-it-yourself' cervical cancer screening I might just shut the door. Although the logistics of a truly community-based screening program can seem intimidating, I can't help but be encouraged by how eager women are to be involved.

I remember an impassioned speech by Stephen Lewis at a huge HPV conference in Montreal last year. His usual topic is HIV but he spoke about cervical cancer that night, and the tragedy of something that is completely preventable, not only with screening, but with an effective and safe vaccine that is responsible for the death hundreds of thousands of women across the world. Over 85% of those deaths occur in the developing world where there is no infrastructure for effective screening programs.

I heard Stephen Lewis again more recently, on a CBC podcast interrupted by haltering internet when he spoke at the funeral of Jack Layton, previous leader of the opposition. The quote of Jack Layton's that stuck with me was 'Always have a dream that's longer than your lifetime'. Today, my dream is to make cervical cancer a historic disease, this disease that is often called a case study in health equity has no right to take the lives of young women, regardless of where they are on the planet. Check in with me in a decade to see how we're doing.

Blatantly Obvious

The sound of my feet pounding the path was the only rhythm I was aware of as I slowly climbed the incline of the Kololo hills in the rising early morning mist, past embassies and houses that would put the mansions of Shawnessey in Vancouver to shame. As I pass Kololo Heights and start my descent back home, the orange ball of the sun peaks out from behind Ntinda hill sending sunbeams shooting through the low lying clouds in a brilliant peachy fan. Running is good for the soul. A nearby mosque emanates sing-song prayers out into the waking world. Funny, I think to myself, normally their morning prayers are done by this time.

As I drink my coffee, the plan for the day goes through my head, meeting with PATH (an NGO with offices nearby at the WHO building). Then Michael (Doreen’s replacement) and I had a long to do list, check-out labs for processing cervical biopsies, buying a specimen carrier, editing and printing surveys and educational material, we had discussed it all just yesterday.

I show up at the gate of the WHO offices at the appointed time, but have an intriguing discussion with the guards at the gate. No, no one is in the office today. Why? They give me a strange look, a bit confused even. Well, its Eid.

Of course, Eid, silly me, oh well. Having not learnt my lesson I tromp down the hill to Mulago Hospital, get to the office to find the place a bit deserted. That’s funny, Mike and I had this work plan, oh well. When I call him (he’s a good Catholic boy by the way), he says: Sheona, it is Eid, we cannot work today!

I now recalled our scheduling challenges with the outreach workers in Kisenyi:

Does Monday work? No, Veronica’s church has to help distribute the World Food Program food.
Tuesday? Well, Esther is a Muslim, it could be Eid.
Wednesday? Well, it could be Eid.

Of course no one had thought to tell me, its obvious to the rest of the world, the date of the huge celebrations of Eid marking the end of Ramadan can’t be announced until the Imam sights the new moon.

It reminded my of a lovely family from Kerala, India who after recently moving to Calgary experienced their first Halloween. Of course, no one had thought to mention to them that children in their neighbourhood would be coming by, ringing the doorbell, yelling ‘trick or treat’ and asking for candy. Its so obvious, isn’t it?

So I spent the day immersed in epidemiology and statistics, catching up on courses instead. I have to say, I was grateful for Eid!

Debt Perspective

From The East African Newspaper August 15-21, 2011

Kampala Calling

After an unplanned, frustratingly exhausting 30 hour tour of Africa courtesy of Egypt Air which included such notorious airports as Cairo, Dar es Salaam, Kilimanjaro and yes, eventually Entebbe I am now back in Uganda! I had the most surreal experience during my 5 hour tour of the Dar es Salaam airport. Having come through Madrid in Europe, many of my fellow diverted continent-touring comrades were from Spain. So when we were grumbling and groaning about our predicament, naturally, I spoke Spanish, however, when we were given our breakfast coupons (yeah for chips and chicken as the only option for breakfast at 5am!) I ended up sitting with a lovely Tanzanian bloke who works as a lawyer at the Arusha Human Rights Tribunal who had also come from Madrid, so naturally, I switched to Kiswahili….much to the confusion of my newly acquired buddies from Barcelona who hadn’t been able to place my Spanish accent to start with. Surreal. I was post-call equivalent as it was which probably heightened the dream-like nature of the event.

I got to the guesthouse from the airport at 3pm, showered and dropped by the office to check in with our research program assistant. Our to do list was long and I just wanted to pop by, say hi and outline our plan of attack. I found not the woman I had seen in January, no, alas, there was a very very pregnant woman sitting at the desk….very. The baby squirmed visibly across the tautness of her belly beneath her clothes. Although she was expecting me, she looked rather….well, sheepish I suppose. My mzungu self blew up inside of me, why on EARTH would this not be something you would mention to the research program so they could make some adjustments?! But FORTUNATELY, the lovely culturally sensitive, accepting inner being took over, congratulated her exhuberantly and enveloped her sheepishness in a hug. I need to zen out and get with the African way of doing things. When I asked how the pregnancy was going she said “Sheona, why do I feel these contractions every 20 minutes, I don’t understand?” She’s due in three days…life happens, awesome, complicated, real.

As I sit writing this the clatter of the monkeys scurrying mischievously across the tin roof startles me occasionally. I’m staying at the Mulago Hospital guesthouse for a few days before moving into my apartment. The guesthouse consists of two, not quite rustic, not quite luxurious house-like structures set on the slope of Mulago hill surrounded by deep green grass scattered with brilliant purple jacaranda blossoms fallen from the trees and the occasional sharply textured globular Jack fruit, cracked and oozing its sweet white nectar onto the surrounding celebrating ants. In addition to the resident monkeys there are a few large Ibis who wander, searching for bugs in the grass with their long smooth beaks. I’m exhausted, overwhelmed by both the logistics of research and the epi and stats MPH courses that I’m starting. But I’m also overwhelmed by gratefulness, for the opportunity to be here, the thrill of the daily realities of life in Uganda and excitement for the next phase of the project. Life is crazy, but good.

MIA for a Year

There was an intense yet fascinating two week at Hopkins. I’m taking a part-time Master’s of Public Health that will allow me to spend the majority of the year between Uganda and Ecuador working on a cervical cancer research project. The John Hopkins School of Public Health turned 95 years old this year. A world-revered institution that churns out research at an incredible rate and who’s motto is (seriously folks) “promoting health, saving lives….millions at a time.” I can’t take them seriously. The Hopkins medical center is a state of the art institute of modern medicine situated splat in the middle of a ghetto. They shuttle us back and forth from the residence to the medical campus for safety reasons. Looking out the smudged window of the bus I see row after row of brick houses with boarded windows. Is it not a deep irony that this desperately poor and crime ridden community, somewhat of a public health disaster, surrounds one of the world’s leading school’s of public health? With disproportionately high rates of HIV in the African American population that lives there and statistics that show if you are an African American man you will die 30 years before your Caucasian counterpart it makes me suspicious of the program I’ve just signed on for.

Regardless of all the irony and healthy ego of the institution, I am awed by my classmates. I become quick friends with Sara, a young soft-spoken Southeast Asian pediatric ICU physician from Stanford who loves climbing and road biking and has set up a peds ICU in Kathmandu. One of my small group members was an adviser on the Bush administration’s bioethics committee, needless to say he had to find a new job when Obama came in and is now a health policy analyst at the NIH (National Institute for Health). The list goes on, but I quickly learn that those who surround me are without a doubt the biggest resource I have.

I returned to Vancouver for a frantic two weeks of baby catching which completed the requirements for my Baby Mill Chief rotation! Although unlike gyne oncology, it was far from passing with flying colours, I met expectations. I’ll take that and run. I pray that I never eat my words in the future but if I EVER sign up to work at the Baby Mill when I’m done residency someone please slap me, churning out babies at that pace isn’t good for my soul. July 1st was my last day of call at the Mill. A few of my favourite nurses took me out on the weekend and said the loveliest of things about how much they liked working with me, they can’t possibly have any idea how much it meant to hear that.

And now for a year that will beat to a different drum, I won’t hear the rhythmic thumping of the fetal heart Doppler, the reassuring snapping of sterile gloves on my hands or the smoothness of a scalpel sliding through skin. I’m excited, ungrounded and apprehensive all at once. Uganda, Ecuador, Egypt, Spain…oh yeah, and Baltimore, here I come.

Maternal Death and iPhone 4s

It was a standard beginning to Sheona-style traveling. I book a flight post-call…why not, it’s a wasted day anyway, right? Packing in a mad rush, semi-comatose through security and then exhausted I finally slide into my seat on the plane. Complete relief envelops me and I promptly pass out. I awake foggy brained, dry mouthed and with drool caked down the side of my cheek as we begin descent into Toronto. The perfect opportunity for the lovely Nigerian couple (of ‘traditional African build’ as Mma Ramostwe would say) beside me to engage in conversation. They are profs in Washington DC and think Hopkins isn’t such a bad school for me to go to.

After a short flight on a plane smaller than the ones they use to fly to Yellowknife I find myself in a taxi in Baltimore. Ayaad, the driver, is originally from Eritrea.

You know where that is? He turns with a wide smile of surprise on his face.

Ayaad is driving taxi part-time while finishing his engineering degree. We discuss East African politics, Somali-Ethiopian relations and after discovering my profession he tells me the story of how his mother died while birthing his younger sister.

You see, they just don’t have the technology… so women die during childbirth. He explains.

I suggested it is perhaps not the technology at issue but access to it.

We reach the hotel and I hand him my credit card. He pulls out his iPhone, plugs in a little white box to the top and swipes my credit card. I sign the screen with my finger and he emails me the receipt. He notices that I’m quite impressed by the transaction.

You haven’t seen this before? Oh, you much not travel much!

Oh Ayaad, if you only knew.

I need to download the Preventing Maternal Death App.

Chief what?!?

Their times of birth were 1526h, 1527h and 1528h. Three babies in three minutes. Her life has been suddenly changed from the quiet days of strict bed rest up on the ante-partum ward were she was learning to knit and working on putting a quilt together. Now hurled into the reality of having three premature babies, one of which weighs less than a kilogram. She is a recent immigrant to Canada, trained as a nurse. She and her husband have a one bedroom basement suite and he works the graveyard shift at Tim Hortons every night. The Canadian dream, eh?

Somehow I have become a chief resident. No, contrary to life on Grey’s Anatomy, this is not a prestigious position you apply for, it’s a mandatory part of a residency in obstetrics and for the most part I hate it. Your junior residents have an obligation to dislike you because you make the call schedule, and no matter what, it will be horrible because of the sheer volume of hours they have to work. They will always consider it unfair, regardless of how many hours you invest in planning ahead, spreading out their call days and weekends. Your attendings somehow hold you responsible for any case that goes awry, either because you didn’t show up for it, or because you did. Oh yeah, and they don’t like how you make the call schedule either. Nobody is happy.

But enough whining, what I love about being a chief resident is the staff clinic. A clinic run by the chief residents for women who don’t yet have health care coverage. The women are mostly recent immigrants and refugees who go through a financial assessment to qualify to be there. Occasionally they manage to jump through the hoops and a patient shows up with a purse worth several weeks salary but for the most part these women are facing huge barriers to getting care. Not only financial stress but imagine the terror of arriving at a hospital in labour and not speaking a word of English. I love the colourful spectrum of languages and cultures that traipse through the clinic, their faces containing such depth of heartache and hope that it fills me with both. This clinic is a glimpse of why I chose to embark on this journey.

The obstetrician who oversees staff clinic asked what type of patients we would like to see referred, then she laughed as she remembered, “That’s right, you don’t like rich people at all, I’ll try to screen them a bit better!”

Orchids, 70-year olds and Dengue Fever

And then I went from -32 to +37. Ten and a half hours driving through blizzards and freezing rain with logging trucks, not everyone’s idea of a fun day. Then it was my mom’s 70th birthday. She is a phenomenal woman my mother. Its hard to put into words the mentorship she has provided to dozens of people over her career. Her passion for the marginalized often setting her apart from the right wing Calgary community she worked within, who often preferred to turn a blind eye in self-righteous indignation to the needs of the global poor as well as those on their own front step instead of being faced with the discomfort of inequality. But I digress, point is, she’s amazing. After the big party we hopped on a plane together, through Bogota to Guayaquil in Ecuador and then on a bus to Machala, the malaria and dengue capital of Ecuador! Then with some trepidation we put mom on a bus to the Peruvian border, where she caused a minor riot, watched the bus drive off with her luggage and eventually got to the airport in Tumbes to get on the newly minted Peruvian airlines on a flight to Lima for another birthday celebration with my sister. She’s decided to celebrate turning 70 all year, this seems like a good start.

Why come to Machala you ask? Well, the spousal-unit does Dengue fever research here. People describe it as Donde el Diablo perdio su poncho (where the devil lost his poncho). But I must say, it does have a certain sweaty-banana plantation-mango paradise-type of charm once you get a handle on the 37 degrees part. Last weekend we went on a hiking trip through Podocarpus National Park. In the lowlands of the park there were hundreds of orchids in dense humid forests, with plentiful rivers and waterfalls to jump in for refreshment from the oppressive heat. The highlands had amazing bird life and a bit too much of an adrenaline rush in a climb and descent along a steep ridge for several kilometers. Although the view was breathtaking on both days we hiked about 8 km longer than our legs were happy with. We’re turning into old farts.

Back at work this week in Machala, I’m working on a manuscript but did get the opportunity to go to a Dengue community meeting in one of the communities the TDR project is being run in. There was a certain irony in the fact that I got eaten by mosquitoes for the duration of the evening meeting…oh dear. Amazing to see how the project actually works on the ground though.

Eau De Prince George

The sweet yet sour smell of skim milk powder, part chemical, part organic. It wafts across the valley and settles thinly over everything, permeating the environment. Apparently its from the pulp mill, the billowing towers you can see from most parts of town. As I open my front door in the darkness of early morning I get smacked in the gizzard both by the sharp, biting cold accompanied by the tangy odour singeing my nostrils. I've nearly been up here three months now, granted with a short interlude in Uganda, but it will rank among the best rotations of residency.

Its a strange medical community Prince George, like none other I've seen, they may have missed a memo. There's no open shaming and ridiculing of residents. No pointless scut work to help you build character. The attendings genuinely seem to care about your learning. Strange, very strange. Invites to obstetricians' houses to 'drop by whenever just to hang out', you tend to see your attendings in a different light after competing against them and their kids in Wii dancing.

I didn't know why everyone seemed to care about the HUGE solar flare that happened last week. Northern lights dumb city kid. Shimmering fluidly across the sky, only fading next to the full moon. PG is positively charming, I listetned to a home grown white boy reggae band on Friday night, not something I would have done in Vancouver. Although, unfortunately I started mocking them with the lead guitarist standing right behind me...shoot. Next to my front door are a pair of Sorel boots, snowshoes, hockey skates and cross-country skis...it just depends how much time I have and how cold it is.

The cold was a shock to my now pansy-fied Vancouver-accustomed system and the irony of spending an hour digging my car out of a snowdrift so I could go for a swim in the local pool was not lost on me. Also, FYI, snowshoeing at -32 C is not recommended without significant toe frostbite protection, my eyelashes were fluttering with ice at the end of it. But the benefit of the all too accessibly snow is that 15 minutes after you get off work you can be out at Otway skiing for a few hours, either as the sun sets, turning the clouds yellow to peach to brilliant orange or under the brightness of the stars above.

Whereas at other community rotation sites where residents have the highest chance of being called a ‘tard’ (as in retard) or ‘cretin’ for their OR skills, in PG you have the highest chance of being called ‘sweetie’, ‘buddy’ or ‘love’ and fed by the frequent OR ‘food fests’ to within inches of your life with delicious homemade dishes. I felt affirmed, respected and embraced as part of a team. Although I didn’t expect it, I would absolutely work here in the future if given a chance, my soul fund has been topped up.

And now back to the big smoke and the baby mill…well, with an Ecuadorian interlude that is.

My Screaming Ovaries

There is a divine and messy moment after birth. I peeked my head around the door to see if the baby had been born yet. It was one of those consults that causes obstetricians to go into early retirement. A recommendation for assisted delivery had been made, and it had been declined. One can only step away and wait. Regardless, the parents were lovely, both well along in successful careers.

So it was with a wave of relief that I witnessed this tender moment. An exhausted but exhilarated mother holding her naked child against her chest, the father leaned in close, tears streaming down his face, tenderly kissing the top of his daughter's head, telling his partner how much he loved them both.

But the pediatrician walked back and forth restlessly, the babe had to go to NICU. She was much sicker than expected and needed multiple interventions. Later that night I found out baby had been urgently flown down south for further care. Mom and dad were going with.

Dread. Nausea. Sadness. Guilt. I can't find words to describe the feeling. Should I have made a fuss? Demanded delivery? Pulled the "your baby will be gorked if we don't deliver it now" line? Would that have made any difference? No one can say.

The next day I called the NICU down south to see how baby was doing. Not good. On ECMO (a heart-lung machine for babies) with uncontrolled pulmonary hypertension. The baby had a common trisomy and the parents were giving her up for adoption.

My ovaries screamed in unison and my heart exploded. I jumped in my car, drove the 10 hours down to Vancouver in the snow, only wanting to wrap that baby in my arms and love her for however long her life might be. My soul aching, thinking of that tiny baby all alone in a NICU far away.

Okay, I didn't actually get in the car. More just a compulsion to do so.

Damn ovaries.

Unsettlingly Serious

There was a gnawing unrest somewhere deep in my belly as I walked out of the hospital tonight, and I'm not talking overdosing on Timmy's coffee unrest. I could chalk it up to the communal grief of the seven family members crowded into the small assessment room after they found out the baby had died at 33 weeks gestation. A familiar wave of nausea and dread swept over me as I sat on the edge of the bed, searching desperately with the ultrasound for the flapping heart in the grainy picture. The cardiac anatomy was outlined clearly, sitting eerily still and unfamiliar under the railroad tracts of the spine as the taut belly shook with sobbing.

But if I'm truthful, it wasn't just fetal demise that has unsettled me, its that things are getting serious. The weight has gradually but solidly settled on my shoulders. Surgery isn't just cutting and fun anymore...well, its still fun, but serious fun. I did surgery on a woman for uterine cancer last week, who made zero urine the next day. Zero. Oh, and developed a sky high creatinine (that means renal failure). I felt sick. My night was spent tossing and turning, in my mind replacing every single suture I had placed, each vessel I had cauterized, trying to figure out how I had tied off her ureter or cut an unrecognized hole in her bladder. I woke up soaked in sweat and nauseous (no, I don't have cancer and I'm not pregnant if you're symptom fishing).

Last night I had to deliver a distressed baby by forceps before the attending could make it, egged on by an anxious GP. As the fetal heart rate tapped out ominously, I did the pudendal block, then slid on the forceps smoothly, double checking their placement. Perfect application as the silver salad tong suctioned into place creating the baby's ergonomically designed helmet. Beautiful delivery over two pushes. Perineum INTACT. Impressive, no? No, not at all, you're not SUPPOSED to pull babies out with forceps sunny-side up Einstein, its not AS ergonomical to wear your helmet backwards. Not a delivery I was proud of. The baby went to NICU, not because of the forceps, because of a fever. Obstetrics can be humbling.

The responsibility of the vocation I'm training for is becoming clearer. An obvious result of the increased autonomy I'm given here. I hope I find the balance between the fun and the fear. You see, I've just never been described as serious before, but I haven't been joking as much lately either. My renal failure lady had an intact bladder and ureters and turned the corner just fine, the nurses went out of their way to care for the grieving family and my sunny-side up baby is breastfeeding with mama now.

P.S. I know unsettlingly isn't a word.

Breech Baby Breech!

Beeeeeeeep beeeeeeeeeep beeeeeeeeeeep.

My phone call to an old friend is rudely interrupted and I go into the kitchen and grab the phone to answer the page.

Code pink, vaginal breech, primip with meconium.

At first I think the maternity nurses are playing a joke on me, knowing what the wet dreams of OB residents are made of. But no joke, its for real.

Everyone is there, the OR staff, several dozen folks from NICU (it seemed) and no obstetrician (yet). The baby's heart rate looks lovely, so I consent the mom for a STAT C-section just in case and tell her all about breech deliveries...truth is, we can see a scrotum coming out each time she pushes which would make a C-section quite challenging at this point.

The Grandfather of obstetrics rolls in calmly, shirt and tie with scrubs top over top as his signature outfit, and peaks over my shoulder. His only words, in his usual unflappable manner and quiet voice:

Looks like the little guy's pecker is pointing up there, I suppose you'll be getting ready for an episiotomy.

Right, of course...as I scramble to get some local anesthetic. The delivery is beautiful, the kid starts screaming and the crowd disperses fairly quickly.

I notice a huge blood clot has dolloped onto my jeans during the process, which I hadn't had time to change on the way in. Well, in the grand scheme of things, that delivery was worth a good pair of jeans!

As I head to the nurses' station to do the paper work feeling rather exhilarated, the Grandfather says: Great job, now you can do them in your practice, right?

Right.

Uganda's Top Five

5. Sam Luboga - His gentle manner and soft voice win you over in seconds. He has every right to be a successful academic general surgeon with a healthy ego to boot but his humility is palpable. As we sit around a table in the now empty waiting room of St. Stephen's hospital he tells us the story of how the small community hospital came to be.

You see, they would come and knock on my door, I would spend the day working and then come home to a line-up of patients. It started in my office at home... I simply could not ignore the need. So we started St. Stephens.

His young protege gives us a tour of the small but clean and organized hospital, we all agree we'd rather deliver here than as part of the mass of humanity at Mulago. Sam's hair is now mostly white, his smile gentle and his laugh genuine. His clerical collar (since he has also trained as an Anglican priest) seems to make him even more approachable instead of unattainable and intimidating. He has 'adopted' over a dozen children, mostly from his siblings who have passed away, from AIDS and other life circumstances. I have no doubt he has made more of an impact on this community than the most well-published of academic general surgeons could ever hope to.

4. Jean Chaimberlain - They told me she was a spit-fire but I must say seeing is believing, (I briefly may have even mistaken her passion for hypomania at one point). An obstetrician originally from Ontario, she has dedicated her life to developing a Masters of Public Health in Maternal Mortality at Uganda Christian University where currently professionals from across East Africa are being trained. I felt privileged to meet some of her students and was blown away by their dedication and passion, some were government health officials, nurses, social workers and business people who all work full time in addition to taking the course. She makes no excuses. Not for her faith, nor for the relentless drive she has to affect change in a world where a woman dies needlessly every minute of everyday from a pregnancy related cause.

3. Veronica Najjuma - She must be nearly 60 but to me her wrinkled face seems ageless. Rarely without a smile, always some type of floppy hat on her head as she sets out into her community of Kisenyi with a message. Whether related to cervical cancer or a town meeting, she spreads the word with determination. She's a village chairperson and one of the research assistants that I've written about previously. In January of this year, I visited Kisenyi again, but this time with an entourage from UBC. Among them, the head of gyne oncology, the Canadian infectious disease in pregnancy guru and of course my fearless research supervisor herself! I have worked with these attendings in a very different context than the dust and garbage that surrounded us in the slum.

Veronica had been charged with a tour of Kisenyi which she took seriously. First to the houses that had been burned down just three days before, two children had died. The wooden shacks are crowded so close together that the fire had destroyed a dozen houses within only a few square meters. Next she lead us to the brothels. We sat in a tiny courtyard, crowded on tiny wooden stools as Veronica chatted with these women about HPV self-collection. To be there, having my attendings, a group of driven women who are leaders in their fields, sit and witness the stories of a group of women so different from themselves, some of the most marginalized, was a powerful and moving experience. They had recently been involved in an HIV microbicide trial and were wary of pelvic exams, saying speculums had caused HIV in some of their friends. Veronica engaged them in conversation, her openness drawing them in.

2. Florence Mirembe - aka The Queen of Africa. Previously the head of the department of Obstetrics and Gynecology. She may have done more than any other woman in Uganda to forward women's health. She is a trained obstetrician-gynecologist and a long-standing professor at Mulago Hospital. I remember going to morning rounds before I had met her and leaning over to ask one of the junior doctors in a whisper what her name was. He looked back at me incredulously, "that is Prof Mirembe!" She certainly had a presence in the room, admonishing the interns and registrars to higher standards

"you knew she had a previous Ceasar when she came in in labour, and now you have risked her life and taken her baby's life from her because you waited for her uterus to rupture before going to theater!"

No apologies, just pure passion, decrying the injustices of a system without resources. How can a woman who has not only lived through the dark times of Idi Amin but also witnesses unspeakable tragedy at the loss of women's lives not have become jaded? Not have come to lower her standards of care? How does she maintain that fiery compassion in the twilight years of her career when she could be relaxing a bit more? I have trouble not getting jaded and I'm only partway through residency!

1. Allan Ronald - In all honestly I didn't fully realize who was coming over for dinner, over the past two weeks we had innumerable meetings with a variety of phenomenal individuals and names were all starting to blend into each other. So Allan Ronald took me off guard. He is humble to a fault, down-playing his involvement in a massive HIV trial currently taking place. He is somehow able to connect personally with everyone in the room, he leans forward engaging me in conversation, interested in what my plans are. Then, looking me straight in the eye puts the entire responsibility of saving the world squarely on my shoulders. "You need to change how CIDA works, you need to transform the way health research and development are done, its up to driven young people to do it."

As it turns out Allan Ronald has not only received the Order of Canada and been inducted in to the Medical Hall of Fame, but he is the foremost infectious disease physician and microbiologist in Canada and was at the forefront of developing the infrastructure for the hundreds of thousands of Ugandan's who have received antiretroviral medication. He is a leading HIV researcher who spent 30 years involved in research in Africa. Sadly, I heard he has been diagnosed with advanced stage cancer, something you would not have know by the hope and inspiration oozing out of his every word as we sat and discussed international development over dinner. Everyone was a bit starry-eyed as he left that night.

The Top Five have left me humbled, inspired and unapologetic about what drives me. As the slog of residency continues, the day to day of baby-catching, sleepless nights, coffee-jittered days. The endless learning of surgical techniques and the challenges of clinical decision-making threatens to convince me that all there is to my vocation is getting babies born safely and hysterectomies done properly. Not to sound cliche, but these individuals, all in different ways, have been a thundering waterfall on a parched and disillusioned soul, overwhelmed by hope in the face of a much greater need than someone with painful periods wanting a hysterectomy.

OB/GYN Residency