Not for the Faint Hearted

By Sara Brown

It’s hard to describe in words what I saw today. Especially without making people queasy…

Dr. Nicol is doing an autopsy research project. She is having tissues collected to have them analyzed for drug levels to determine penetration. Specifically, she is looking for medications used to treat HIV (antiretrovirals), Cryptococcal meningitis and tuberculosis in the brain, female reproductive tract and bodily organs. These drug concentrations will be analyzed for their potential use as pre-exposure prophylaxis (PrEP) to reduce the likelihood of contracting HIV. Dr Nicol talks more about this project in this previous post. Prosperity is also working with Dr. Nicol on this project and she was very excited this morning when she told us the news of the arriving cases.

Prosperity in her PPE 

Instead of going on ward rounds, Kunkun and I went to the Mulago hospital morgue to observe. It was quite the experience, to put it mildly. Prosperity was a champ; she got donned in personal protective equipment and went into the morgue first. Since it is a small building, we figured we would take turns and rotate through. While Prosperity was inside, Kunkun and I waited outside the building. This was the worst part for me. My imagination was running wild and I was expecting the worst. The anticipation was killing me. Finally, it was my turn to go in. I was taken aback by what I saw, but oddly enough, I eventually got used to it. I was so curious; I wanted to look at everything, but at the same time didn’t want to look at the bodies at all.  I wouldn’t say I was comfortable there (I will stick with pharmacy as a career) but I didn’t vomit or get nauseous. I was impressed by the pathologists’ work. The bodies were well-taken care of: the cuts were clean and precise, and the stitches were phenomenal.

Thumbs up

Once I first got into the morgue, I slowly walked around and observed. A pathologist quizzed me on an organ he was holding: it was a spleen, not a kidney (anatomy was a long time ago--I will stick to pharmacy). He then asked me what the black spots on it were. I said cancer. Wrong. He said it was disseminated tuberculosis. After 10 minutes of observing pathologist, I turned to Paul, the research assistant part of Dr. Nicol's study. He and Prosperity were in charge of ensuring the tissues were collected and labeled correctly according to the protocol. It was a tedious and time-consuming process; we were there for a total of 4-5 hours. Around noon, we were shocked that we were hungry, despite being surrounded by appetite-suppressing views.We were thoroughly exhausted and starving. I wanted nothing but a shower.

Couldn’t rest yet, though: next step was to bring the samples to the lab for storage. We learned some things during the procedure that may improve the collection process. Kunkun and I will help Prosperity write a best practice procedure for collecting samples.  

The pathologist, me and Paul after we were done

We left the lab in search of food. We must’ve looked terrible because a security guard herded us directly to the door of the Good Samaritan food joint we were trying to find. I shook his hand in gratitude. We wolfed down a plate of rice, beans, spinach, skewered goat meat, YAMS (they call them sweet potatoes here, but they are indeed yams—there’s a difference, look it up), beef and coleslaw. I chugged 2 liters of water. We then trudged up the hill back to our respective beds, still thoroughly exhausted.

Being in a morgue in Uganda was a once in a lifetime experience that I will never forget (I can’t forget because these images are burned into my memory...). As with everything else on this APPE, I am so grateful for this unique opportunity to learn about healthcare in an underserved region. I will definitely be sticking to my pharmacy career, though—I made the right choice.