Monday, June 26, 2017

6/24

On this blog I've always wanted to be honest about  my flaws and humanness. Just because I'm a missionary does not mean I've even remotely got things figured out. As soon as I start thinking about outward appearances I see it first here, on social media. "What can I post or write or show pictures of that make me look good (or at least like I'm not falling apart)"?  So here is me trying to be honest again. I need to admit that I'm a bit unmoored right now. Webster says this means "to loose from anchorage." But the second definition is "to bring to the state of riding with a single anchor after being moored by two or more" and I like that one better.

I know in my head that I can't keep functioning the way I was in Soroti. After this break I could go back to it and survive and maybe even do some good for people for a bit again but I'll be right back to this place. The suffering and needs are just too much. I don't know how to give what I can and not be overwhelmed by the magnitude of the remaining needs. So, something needs to change. I don't know what that is. Do I need to find a medical team to join? Possibly in Karuma, or Jinja or Mbale? Do I need to do something radically different in Soroti?  Am I still being called to work in Karamoja?  Am I supposed to be done in Uganda for now?  I don't have the answers to any of these questions and God has been very quiet when I ask (over and over again.)

So for now I'm resting and praying and trying to take small steps. I'm trying to deal with false guilt and real anger.  And for the first time in awhile I experienced God's presence in a reassuring way. I'd been missing it for a frustratingly long time. God reminded me in my quite time today how important my daily bible reading was. I was still readying and studying it but merely as a hoop to jump through early in the morning. Thanks so much to all of you who have been praying for me because "you have not because you ask not" applies to our scripture reading as well.  I had not been asking or expecting anything from the scripture I was reading for quite a while now.

Setting your mind on things of God leads to enduring delight, genuine joy. I'd been missing this for too long. The suffering and daily grind seemed to be all I could see. There was no joy in it. But, He is restoring His joy. Mostly it is in swimming and my nieces and lots of manual labor but I'll take what I can get.

Monday, June 19, 2017

Newsletter

I sent an update/newsletter out early May but I'm realizing how few people got it. For those of you who didn't, sorry and here is the bulk of it.....

It is always an adventure here in Soroti. My watchman just came to the door to tell me he saw a cobra in the garden and he suggests I keep the kitchen door closed. So besides snake hunting, I’m keeping very busy with regular clinic work three days a week, lots of home visits and occasional teaching in a variety of venues.

Because my work permit is now being issued through the church in Obule I’m in the village almost every day of the week and the needs are overwhelming. It seems like there is almost always a woman laboring in the clinic or someone who needs to get to the hospital or malnourished kids who need follow-up. I love working with my tiny village church that really has the heart of God and serves sacrificially. The daily grind, however, has really worn me down. The needs are endless. I’ll be honest, I’m struggling right now. So I’m taking some time off. I’ll be back in MI for six weeks to rest, pray, spend time with family, take a break from this place and get my head on straight. June 21st to Aug 7th. It is a short time and isn’t a furlough so I won’t be doing the regular home assignment activities.

Prayer Requests:

  • Wisdom and discernment. I’m inquiring of God if He has ministry changes in store for me. Please pray with me that He would show me His will and I would have the strength to be obedient to it whether it is to change or keep doing what I’m doing. 
  • I’ll be attending a spiritual retreat for cross- cultural medical providers and also meeting with a counselor to deal with some burnout when I’m in MI. 
  • Rest in God’s presence and trust in His goodness.  Peace, contentment and joy in Him alone.

Wednesday, June 14, 2017

Travel

If you ever have the opportunity to travel internationally with me, may I make a suggestion?  DON'T. I do not have a good track record lately. I'm pretty sure I've missed more connections in international airports than any other person I know. This last trip was no exception. I left Soroti at 6am and got to the airport in plenty of time, around 4pm, with a scheduled departure of 6:30pm. By 7pm the plane was still not to the airport. We learned later that Saudi airspace was closed and so the incoming Qatar plane had to add two hours of flight time in order to go around. Then turn around for the plane in Entebee took at least an hour because Ugandan's just can't move quickly so our departure was more than three hours late. Then the five hour flight took seven so I arrived in Qatar more than two hours after my flight into the US left. So I was re-booked (along  with the majority of the plane so it took awhile) at 4am for a new flight that didn't leave for seven more hours. We were all given meal vouchers and reminded that it was Ramadan so food couldn't be purchased or consumed after sunrise. I was so tired I found a tolerable chair and fell asleep for awhile, was woken by a cleaning crew at 5:30am only to discover I missed sunrise.  I tried to tell myself I would be fine but after doing the math and realizing that it would be more than 12 hours since the last time I'd eaten if I waited for the next in-flight meal and I was already too tired and irritable I'd be dangerous if I added really hungry to the mix, I pretended to be pregnant so I could buy a juice. This lie doesn't bother me at all.  Another challenge in Doha was that I somehow needed to get word to my family that I would not be coming into GR on the flight they thought I was. But my little Ugandan phone was useless and due to the airline electronics ban (for all flights into the US from middle Eastern countries), I had checked anything else I could have used. The airport does have a place where you can use computers so I got a message out but I suspect it was a bit cryptic.....

Anyway, I did finally arrive in Chicago though that continues to be the worst airport in terms of courtesy and reasonableness. You are treated like a criminal in customs and immigration, even if you are an american citizen. I can't imagine what it is like for foreigners. I want to make a shirt that I'll call my travel shirt. It will say something to the effect "I have not slept prone for more than 36 hours, I'm eight time zones ahead of you,  I've eaten nothing but airline food and I've tried to use several currencies. I want to be compliant but I need you to speak more slowly, enunciate a bit and stop yelling at me." I know it is too much for a shirt but a girl can dream right?   Three or four weeks ago, in Soroti, my watch broke and I kept trying to duct tape it but when it got wet the tape would slip. So I used a heavy gauge retention suture and stitched it on. I didn't even think of it in the airport and had made it through at least six security points before Chicago but it was there they pulled me out because I had to take my watch off. I tried to explain that it was sutured on. They said it didn't matter, it had to come off. I said, I'm willing to take it off, just not physically able. If they wanted to give me something sharp to cut it I would. They explained it was a security point, no sharp things allowed. I kid you not, it took me more than an hour to clear this check point.
Anyway, 9pm Thursday night, almost exactly 48 hours after I began traveling from Soroti, I arrived in Grand Rapids. I think my mom fed me and I'm pretty sure I found a bed but it is all a bit hazy.
So, cat is out of the bag.  A few of you saw me at church on Sunday. I'm back in MI a few weeks early. I came back because.... you know, if you say "I'm not sure I can do this anymore" out loud enough times, it becomes true.
Friday AM found me headed to the hospital to do some teaching about HIV and I got a frantic call from the grandmother of baby Jennifer. (First blog here.) She told me Esther had dropped the baby and she was now "acting strange."  I met them on the way in from the village and it was obvious from the moment she handed her to me this was a dying baby. We rushed into the hospital and I commandeered a treatment room for a set of vitals. Later, upon further questioning it seems Esther actually shook the baby because she wouldn't eat. She was extremely dehydrated when I first got her so I'm not sure if there was something more going on before the trauma or not. We rushed into the NICU where we did all we could with our limited resources but at noon I unhooked her from everything and handed her back to her grandmother to take her final breaths. Then grandmother needed help transporting the body back to the village so I took them home. Esther didn't know yet the baby had died and it was terrible to see. This mentally handicapped mother knew she was the cause of her baby's death. She started screaming and throwing herself on the ground. Most of what she was yelling was in Ateso but she would switch into English and tell the baby over and over that she was sorry, so sorry. The culture uses wailing to notify all of the neighbors of a death and everyone comes over to see and mourn together and this was no different. Grandma and Esther started the wailing and each new woman who arrived added to the weeping and keening. This baby's death just seemed so needless. We had done so much to give her a good shot at life. I loved this little peanut.
Between her and a few other cases I just needed a break.  The suffering and need is never ending. I tried to take Saturday off and my phone rang all afternoon and there were several people knocking at my gate. It is just as hard to say No and send them away as it is to engage in their need. On Sunday at church a woman brought me her two extremely malnourished children and with tears in her eyes begged for help. I just wanted to go to church and not be responsible for a few hours. But it seems there is no way to be off duty. I feel wrung out and like I've got nothing left to give. I can't seem to find contentment and I know I'm working in my own strength instead of God's. So it is time for a break.  Some prayer and perspective.

Sunday, June 4, 2017

Another little one to pray for

Jarod is one year old and is suffering the effects of someone dumping concentrated quinine into a sub-q scalp IV. Poor little guy has been in for surgical debridement twice and still has a long road ahead of him. 




Holding him down as anesthesia wears off before they are finished.



He is at very high risk for sepsis, meningitis, or any of a whole host of other unpleasant diagnosises on top of the fact that it is really painful and he is terrified. He is extremely malnourished (as is his mother and five year old sister who is the size of a three year old. His cheeks look nice and fat but that is edema from Kwashiorkor.) His father is an alcoholic and I've been out to their home three times and never met him.
We have him admitted at Bethesda because he needs twice daily dressings under sedation and IV abx but I really had to push for his admission. (He was discharged after the first surgical debridement but was feverish and lethargic yesterday and I just can't give him the care he needs at home.) I'm having a terrible time trusting him to the staff there and I just really want this little guy to have a good outcome. Please pray for them and me.
6/6  Update for all of you praying: He is doing really well and loves eating atap and meat at the hospital. He is still inpatient there but all signs look good. Praise God!

Friday, June 2, 2017

Esther's little baby

Esther's little baby died early this afternoon at 18 days old in Bethesda's NICU. She weighted 1900 grams. I wrote about them last here. Please be praying for Esther and her mother. 

Thursday, May 25, 2017

Swimming

Even as I look at these I can't believe how much Soroti has changed in the 7 years I've been here. But we have a really nice pool now. Specifically for kids. The students I sponsor have been begging again and they know this is one of the few things I'll cave on because I love to swim too. 

Well, I agreed to take them. Unfortunately there were literally a hundred kid there. Most who clearly had no idea how to swim. Terrifying!

Anyway, here are my eight. 

They all head back to boarding school on Monday. 

Wednesday, May 24, 2017

Following up

Lots of follow ups today.....
On the 8th I was in the midst of a complicated labor when a lady with a snake bite came into the clinic. She had been picking up firewood and a cobra got her on the hand. I went to see how she was doing today and here is what I found. I know it looks a bit gruesome but I'm actually ecstatic how great it looks.  I was pretty sure there was a good chance she was going to lose the finger at least and for a while I was worried about her life. But this is just routine dressings for a long time and eventually she will be back to normal! 


Then little Mary who had tetanus back in December. She is now a healthy kid. She is still the only tetanus case I have had survive. She WOULD NOT smile for me, which is really sad because she smiled all the time in the hospital (once her muscles relaxed enough that it was physically possible) but I suspect she has a really hard life. She is HIV positive and lives with her elderly grandmother who needs her to work too much to send her to school.



Lastly I stopped by the home of Esther and her baby who is two weeks old today. They are all doing fine and the grandmother reminded me that I was the one that first diagnosed her HIV. I did not remember that but I guess it was significant enough that I blogged about it. TBT...2012 and the next day.

Saturday, May 20, 2017

Family

When I want to be there so much it hurts....
My family grew this week and I'm on the wrong continent.  (By the way, I realized these are slightly confusing pictures, Nick and Katie had a baby, not Chip and Susan.)

Thursday, May 18, 2017

Update on Jennifer and Esther

Update on Esther and baby Jennifer. I first wrote about them on Sunday
They were discharged today (still on some valium) so I brought them back home. 

 This is Esther with her first born, Emma. He is four years old.
Grandma holding baby Jennifer surrounded by neighbor kids. 

This little peanut went home today weighing 2.25kg.

Wednesday, May 17, 2017

I had no idea when I took this job how much time I'd spend teaching. And the strange topics. Today, I taught at a parenting conference. I'm perfectly well qualified for that. 
I'm just kidding. I did teach at a parenting conference but about keeping children healthy. I'm at least mildly qualified for that, I guess.


 Fever, diarrhea, and antibiotic resistance, my favorite topics.

Sunday, May 14, 2017

For my nursing friends, at least you weren't getting transfer report from me this morning. Me: "I'm bringing you this patient from Obule Health Center. She is a G2P0 in active labor.She was c-sectioned last pregnancy. I don't know when her labor started as she won't talk. Her water broke about 25 minutes ago. I don't know how dilated she is as she won't let me check. I don't know FHTs as she won't let me near her. She is mad (meaning mentally ill) and HIV positive. This pregnancy is the result of insestual rape." Nurse midwife receiving report: ".............." Me: "Which doctor is on today?" Her: "No doctors currently on duty." Me: ".............."



So, update:  Lets start with the good news. Mother did finally get her c-section.  Both mother and baby survived the experience.  Ummmm, I think that is about where the good news ends. Keep praying.  Mother responded very poorly to anesthesia (general, not spinal). First under anesthetized, then way over. Now, out of her mind. Kicking, hitting, biting. She has pulled out two IVs and her foley. The baby was next to her on the bed for a few minutes and she almost successfully threw it on the floor. Baby is doing slightly better than her mother but also needed serious resuscitation (possibly for the same reason her mother did?!) Tiny little girl. Weighs four pounds. She can't seem to keep her body temp up and power is off so they aren't putting her in an incubator but at least now her sats are holding. We have not successfully gotten Retrovir  (infant antiretroviral prophylaxis) because it is the weekend, but hopefully tomorrow. 
This is baby girl with her grandmother. 

Mother after we had to knock her back out to keep her from hurting herself and us. 


My sediments exactly, kid!

Friday, May 12, 2017

Topping today's playlist.....

Listening to this today. Mercy Me- Even If


I'm stuck at home because my truck is back at the mechanic. So I decided to re-grout the tiles in my kitchen. Though that implies that they were grouted when I moved in. They were not. Just packed with clay. Which is really gross when kneading bread, rolling out pie crust, really anything that touches the cracks between the tiles. So I used a screwdriver to scrape out all the clay and started over. I'm rather pleased with the end result.

Monday, May 8, 2017

Some days are just... rather disagreeable. (I'd like to say just suck but I'm a missionary so I probably shouldn't say that.)

I know it happens all the time and it isn't that big of a deal but it is still a let down when it happens. I had a primigravida mom laboring in the clinic today. She came in late last evening and the midwife was up off and on with her in the night. Around six am her labor stepped up, so by the time I arrived at eight the midwife was ready for a few hours off. I could understand why. The mom was laboring well but needed quite a bit of support. Which is actually a bit unusual for women here, as they tend to labor alone without much intervention. This mom was needier but I don't mind it as it is more of what I'm used to, so I willingly took over. However, there were also 20+ prenatal cases to see. (I totally lost count but finished off a new 500 tablet container of prenatal vitamins early in the morning and at 30 tabs per mother that is at least 17 women that I saw before 10am.)  The  mom was having strong contractions and not handling the pain well but was up moving around and dilated several cm between when I arrived and late morning so I thought we were doing well, except the head was poorly engaged.   We tried lots of different tricks and everything else was fine so it just seemed like we were in for a long labor. Besides, it was taking me forever to get through all the other patients so I was going to be around the clinic for most of the day.  I was checking  FHTs often and initially I would have charted good variability (not that there is any charting here) however by one pm possibly they could have been called variable decelerations but really they were on the way to late decels. Without an actual tracing it was hard to call it but it didn't feel right. And the mother was weary and fully dilated and the head was still high. I was in the midst of discussion with the midwife when we had a snake bite patient come in that kept us all tied up for a while.  Then when I slipped back into the labor room in the midst of a really strong contraction and put the doppler on it barely registered 90bpm, so our decision was made. The good news was in the process of getting her up (leaking amniotic fluid all over the place) and loading her in my truck (that is going to smell nice for a few days) the heart rate came back up.  We made the 20 minute trip into town and I unloaded her directly into L&D. Technically we're supposed to register and crap first but there are a few perks to bringing in more than twenty patients per month. The staff really snapped to and patient was headed to surgery shortly thereafter.

Little side antidote, I usually use the clinic delivery stuff when doing it there but I also carry a delivery kit for home/side-of-the-road stuff. Today I cracked open my own kit because the clinic midwife was sleeping and I couldn't find some of the supplies that I wanted.
I tossed a disposable chux under the patient. (Every american nurse knows what I'm talking about but for you non hospital people it is this thing. We use them for any and every leaking fluid. As a matter of fact, even if you aren't leaking anything, but might be in the future, you get one tucked under you somewhere.) Well, the clinic staff went nuts. They think this is possibly the best medical innovation ever. Now, I've given them a doppler, an autoclave, a BVM, an obstetric calculator, and a variety of other things to make their lives easier. This one takes the cake for them though. They have requested a carton. I had to sadly explain that I only have three left and I am saving them for emergencies.
In other news on this lovely Monday, my dog has been missing for three days and is presumed dead. It seems that no amount of attempted bribery of the neighbor kids is going to bring him back this time. Also, one of the secondary school kids that I sponsor got really good marks this term and I had promised if he got Division 1, I would get him into a better school. He really impressed me with his hard work, so early this morning he was over to get the necessary requirements to transfer. Then he proceed to steal 300,000 shillings when he though I wasn't looking. This like three months wages for many people here. This is the third time he has been caught stealing from me. (How many times have I not caught him?!?) So we are done. Completely. What he stole was less than half what I would have paid in school fees for him next term so I can't figure out what he was thinking. More than anything else it makes me sad because he has such potential. But lets be honest, it also makes me pissed off. Oh, that seems like another thing missionaries shouldn't say.


Thursday, May 4, 2017

Mango season and medical pictures


There are thousands of pounds of mangoes just dropping off the tree and rotting right now, so this week Christina and I showed several people how to preserve them. We peeled, cut and dried several full basins of mangoes.



Also, completely unrelated, but because I'm pulling pictures off of my camera.....
I'm getting much faster at suturing. Now you no longer need to chose between quick or neat. Possibly you can have both if, like this young man, your bull's horn catches the inside of your arm. 

Also, I've put on my first hip spica cast. This is mid way through the process and after my patient received a dose of morphine.  


Also, I have a little guy with clubfoot who is almost finished with his casts.

Sunday, April 23, 2017

Alcohol

So some fellow missionaries shared this video that gives a good look at the problem of alcoholism in Uganda. The language in the video isn't great but it is a pretty accurate portrayal of the issue.  My chief complaint about it is that he doesn't actually get very far out of the urban area. If he had he might have found that people use the booze as food instead of with food. And in Karamoja the kids are often fed the dredges of making the alcohol. I still recommend watching.

Video

The missionaries who posted this also discussed why chrisians don't drink at all here. Also worth the time. Their blog (also with the video)  here.

Saturday, April 22, 2017

There, I said it.

God fixes thing right? I know He can. God intervenes in people's lives. He can. He has the power to do the miraculous. Sometimes He chooses to.  And it hurts so much when He chooses not to. I trust you Lord. You can fix and heal and mend and set right. But then you don't. And this erodes my hope and confidence. And it hurts. It becomes easier not to hope and just stop praying that He'll fix it.But then what?