A week full of HIV

Over the past few weeks I’ve been writing some curriculum to teach about HIV and AIDS, with topics like stigma, prevention, living with HIV, caring and compassion, end of life care and leadership from the church in the community. I’ve enjoyed working through this and making it understandable and culturally relevant.  Next week I’ll spend my days teaching it with the goal of increasing awareness and knowledge to promote compassion and the love of God.  I’ve seen things here in the last few months that have increased my urgency to get this material into hands of Christians. Most AIDS teaching comes from the government and is considered “secular” so the church throws all of it out instead of taking the good from it. So, even the most basic things, like how HIV is transmitted and treated is not well known.  Also, even with Christians, those with HIV are shunned, neglected, abandoned, then left to die.  Yesterday, I went with Josh to one of the locations he teaches at. He was teaching about marriage and family but it will be similar to how I’ll teach so it was good to listen and learn. He does a really good job making the material inductive and keeping his listeners involved. I hope to do half as well next week. Will you pray for our time?  I really want the week to be something that helps people and is relevant but most importantly communicates God’s love and biblical truth.

Josh and translator

Worship before beginning. 

6 chronically ill, mentally and physically handicapped kids

Let’s see….I want to write about today before it becomes tomorrow and I become busy but I don’t even know how to put today into words. I could just tell the day like a narrative like I usually do but that wouldn’t touch the peace and supernatural direction that I felt. I know there were many praying and I want you to know God was present and amazing.  That being said there were many sick kids today . Word had spread that I was coming…

Here is just a glimpse:

• 3 month old girl, some congenital birth defect that I can’t put my finger on. She has low set ears and close eyes. Her legs won’t straighten and her cry isn’t normal. But both her mother and her father were there (which is very unusual for this culture) and treated her with open affection.
• 11 month old girl, a congenital heart condition. She is on digoxin and furosemide and has been for the past 8 months.  I have no idea how she got the diagnosis but it is in her health record and her dad had a chest x-ray (the only radiology study she has ever had) with a grossly enlarged heart. They have been told that the only thing that can help them are hospitals in either S. Africa or Egypt. She needs a heart transplant.
• 5 year old (super cute!) little boy with obvious autism.  He wouldn’t look at me and flapped his hands the whole time. His father says he can feed himself but that is all. He defecates on himself and won’t try to speak. He is the 4^th born and his older siblings help with his care.
• Another boy with autism. This one was about 3years old and trying so hard to walk. He played with his little sister and yelled at his mother.
• Then there are the ones I regularly visit. Job is unresponsive and his mother reports he is having frequent seizures. I explained my concern about his blocked shunt and how there is nothing we can do. 
• And Lazaro. Who just lays and stares at me. Even in the states we could do practically nothing for his osteogenesis imperfecta.

I think God was showing me again that I don’t have anything to offer. Could He have chosen 6 kids with illnesses that I can do less about?

All of these were gathered in a small patch of shade, having walked or put their handicapped child on the back of a bike in the 90+ degree heat. I sat looking at their faces. Why did they come? I want to offer hope of a cure. But I can’t. However, I can offer hope of healing. But not in the physical sense. It came to me gently and the words just came out. I asked my translator to make them understand what I was trying to say. I began to talk and they all listened. I have the hope of Christ to offer. (Acts 3:6) They listened better than any other time I’ve talked and it came out easier than any other time I’ve shared. T

hey still asked me for money and food and medicine and this time I really didn’t give much of that. But tonight as I write I’m content and at peace with the day. I think I did what God wanted me to do.

I’ve gone back and read this again and thought through the day one more time and I'm sorry. It still doesn’t really touch on how today felt different in the village. I just don’t even really know how to share…. 

morning prayer

So, I'm headed out to the village in a few minutes. I was dreading it, but after a hard run (thanks Jillian!) my head was cleared enough that I could hear God reminding me that its not about me.  It's not about what I can do for these kids. (John 3:30)  When I look at how little I help, how I can't really make a difference, I get so discouraged. But I work for a guy who does greater things than I can even think of. So, Lord, I surrender the day to you. Help me hate the suffering of these small ones because you do, but also help me not let it steal my joy. Remind  us all of your strength. May your kingdom come, may your will be done. Keep my eyes only on you Jesus. Amen

In over my head again...

                                      * 1/23  Posted late but this one needed some processing first…

I hate days like today...I feel completely overwhelmed by the needs and the suffering.  

This morning Andrea (long term team mate who is passionate about vulnerable kids) and I headed out to check on Lazaro. It was going to be just a quick check to see that he was still mostly healthy. Because I really didn’t have any other intentions for the visit I just brought Abella along to translate for me. She does really well considering she is only13 years old, translating is hard enough already and she is trying to translate me from English into Teso but Lazaro’s family speaks Kumam.  I usually bring a Kumam speaking adult but today wasn’t supposed to be complicated….

We arrived at Lazaro’s hut only to discover that today was clearly not a normal day for them. 

Decorated for the bride's family

Building a structure for shade

 There were about 4 times the number of people around, they were constructing a shade for a big group and the place was clean and decorated. It was Lazaro’s step sister’s introduction day. (Kind of like an engagement party for the two families to come together and fight over the bride price.) So everybody was busy but they set us in the shade and we waited for them to quickly bathe Lazaro and bring him out. While we sat, an elderly grandmother who I had helped get a walker for her grandson sat down next to me. She told me she was so happy to see me but she was worried about Albert, her grandson. She hadn't seen him in months as he was back with his mother. I know this mother to be very neglectful which is why he was with his elderly grandmother in the first place. It was too far to walk and would I be willing to drive her to check on him? I said I couldn't today but we could go Wednesday morning. She was very please and stayed sitting with us in the shade while we waited for Lazaro. It was becoming a long wait as another mother of one of the other kids I check on came up to me. (I think she had been helping to prepare food.) She said her son Job has been really sick and would I look at him too? I told her yes and she took off to go get him. Lazaro looked pretty good but he has a broken wrist. I guess he was being carried by a brother then wasn't any more. It is amazing that more things weren't broken when he fell. While I was trying to figure out if the wrist could be splinted Andrea shared a little with the women that were surrounding us. Then there was some singing and dancing- these ladies were ready to party! It was clear there was lots of preparation left for the introduction so we began moving back to the car. Job’s mother had not yet returned so we waited for a few minutes. Next thing I know there is a small crowd gathering around us (of clan members who are arriving for the party) and some one placed what felt like a newborn in my arms. Where did my translator go?! As I unwrapped a little I discovered it was a baby but only the weight of a newborn. Her little knees were contractured so tight against her belly and her heals tight against her buttocks.  I couldn't get any idea of what was going on as there were three people trying to tell me and my young translator was not getting any of it. Three months old maybe. But I couldn't understand if anyone knew what caused it or how long she had been like that.  As only can happen in the village the crowd was growing exponentially and I just can’t handle that. So I handed the baby back and promised to return.  I started to extract myself from the middle and another man grabbed my arm. “You come see my child.” At least we were functioning in English again… He had a kid with a heart condition (?!) that needed help. The child wasn't at this home, at another in the village so I agreed to see that one also when I return. Then I bolted for the car. When Abella had disappeared she had found a sibling of Job’s who was helping to build the shade and he guided us through the bush where Job’s mother was just getting home. (Good thing we didn't wait for her!)  Job has clearly lost a ton of weight. His little arms and legs were just bone. Abella really struggled to understand Job’s mother (also a Kumam speaker, not her native Teso) and help me understand. I think the long and short of it is his VP shunt is blocked. She took him to the neuro hospital in Mbale where he was tube fed for a two weeks but she had to bring him home. (no more money?)  He still wasn't eating but she said he would drink. While sitting there struggling with what to do, I developed a headache.  I could give them more money to go back to the hospital but for what? More weeks of tube feeding? If they didn't replace the shunt the first time I didn’t think sending them back would do anything.  So do I supply them with protein rich formula? But he seems like the best candidate for aspiration pneumonia I’d seen in months. Palliative care? Ideally I should lay it all out for his mom. Help her understand how he could choke, how there wasn't medicine that could help him be able to eat again, how there was so little we could do. But that conversation isn't easy when we share the same language and I’m not trying to pass it all through a child translator.  So I encouraged her to keep doing her best and I’d come back…

So tomorrow is the day I go back. I’ll attempt a splint for Lazaro, attempt to find Albert make sure he isn’t being neglected, attempt to explain some things to Job’s mother and help her decide what to do for her dying son, attempt to check on this little girl with a heart condition and attempt a diagnosis or at least a plan for the family of the little girl who can’t move her legs. I have a Kumam speaking adult translator lined up but he and I don’t work super well together because I feel like he doesn’t translate exactly what I’m saying, he makes promises for me that I can’t always keep and he tries to tell me what he thinks I want to hear. I am already afraid I’m going to come home with a headache….

Little gifts

These are just a few things that made me smile yesterday:

I love fresh eggs from my new hen house.

My cat sleeping on the mop- guess I can't do the floors this morning.

Monkeys playing as the day cools down. 

A beautiful sunset to finish the day. 

 What neat little gifts did God give you today?

I haven't had to "chart" in a while...

Pulling at left ear, membrane red and slightly bulging upon exam.  Persistent low grade fevers. Nasal congestion. Breathing even and unlabored. Alert, age appropriate behavior.  In the past three weeks has been on amoxicillin then augmentin without improvement. Weight: 16.6 lbs (7.5 kg)

Impression: Drug resistant Otitis Media

Plan: Started on Ceftriaxone 50mg/kg/day.  375mg IM x 3 days

Cough, audible inspiratory and expiratory  wheezing with congestion. Crackles and rales in bilat lower lung bases. Dyspnea without exertion. Resp rate: 60. No retractions. No measured fever. Alert, age appropriate behavior. No indication of pain or other complaints. Weight: 9.5 kg

Impression: Early pneumonia               

Plan: Started on Ampicillin 50mg/kg/day PO q6 hours. 80mg (3ml) Give 1 hour before or 2 hours after food.

       Treating team mates. My least favorite thing to do. 

Twins

 Here is an update on the two precious twins I went out to see last week (their story here): They are both doing well. The little girl hasn't seemed to put on any weight but is still strong, I'm sure she just needs time. The little boy is quite a bit fatter than a week ago.  I'm happy to report they have been given names, Apeo Mary and Ochen Joseph. (Apeo means first born girl of twins and Ochen means second born boy of twins).  The fact that they have been given names means that their father doesn't think they are going to die anymore.

I love going and seeing that they are doing well and giving the family things they need. I gave them more formula, soap, sugar and these warm blankets. They babies looked tiny wrapped in these big soft blankets but I'm sure they will grow into them. The mother kept saying God bless you. I told her I just get to give away what was given to me, so once again thanks to all of you who made blankets and gathered formula. These little two have a very appreciative mother!
One other picture just for fun- we walked a little ways to get to their home and this was an angry cow on the path that wouldn't let us pass. It always an adventure here!

Weekend Away

 This past weekend Jillian (a Canadan friend who also lives here in Soroti and works for World Vision) talked me into taking a weekend trip. She was considering a resort with a pool and masseuse.   Then somehow Saturday morning we found ourselves headed up to Karamoja. I’m sure she was asking herself what the heck she was thinking while lying under her truck the first time.   Several bolts that hold her bullbar on (possibly liberated to new owners?) were missing so the connecting rod had snapped with the added weight. Due to the exceptionally poor road conditions we were very concerned that if we let it continue to bounce that the second rod would also snap, (it was quite heavy, trust me I was the one holding it up while she tied it back on!). So we cut some rope off the tarp she keeps over the back and tried to tie it back on.

Just a little glimpse of the road we were broken down on.

The rope rubbed through in a few very short kilometers. So we pulled over again, still in the middle of nowhere and put it back together again- this time with newspaper too and managed to make it to Iriri. 

Who says you can't fix a car with rope and newspaper

We found some nice guys who would sell us some bolts and even installed said parts for us. An hour later, after wandering from one end of “town” to the other, took all of 5 minutes, and sitting in the "general store" for a while, to receive stared from EVERYONE who walked through "town" the car was put back together and we drove the remaining hour and a half without incident.  We had a nice restful weekend hanging out with Heidi, playing cards and cooking together. Sunday we packed back up and headed back to Soroti. 

Heidi and I outside her house. 

The highlight for me was the few day old baby ostrich that is living on their compound. She loved people and would follow feet around for hours.  

Few day old baby ostrich.

This baby would fall asleep in my hands. So sweet. 

Jillian, who was thinking of a massage this weekend but
instead got a makeover. 

* The formating on this is ridiculous and blogger is ticking me off tonight so I know the font changes 3 times and the captions/pictures/text are messed up but I can't seem to fix it. Sorry.  

Two hungry babies

Here are baby boy and baby girl with their mother
(who really didn’t want to look at the camera).

I heard yesterday about two newborns out in a nearby village who were starving and could I do something for them? So after a night of nightmares about gavage feeding starving babies I headed out to see them this morning. I’m happy to report that it was not as bad as I feared. 

Mother trying with the syringe and grandmother on the left supervising. 

Dad holding one and an older sibling on the right.

All sitting outside their home. 

They have not yet been named as their father was sure they were going to die. Their mother, as they say , has produced 6 times. And she says she has never had any milk. Two other babies died before they were 3 months old because of lack of milk. Three others survived but were sickly and malnourished. Then these twins came. Their father says last time he couldn’t buy enough cow’s milk for one child and now he needs to get for two babies!  So these two little ones, at 3 weeks old, have been surviving on one shared cup of milk a day. I’m estimating that the little girl weighs around 2 kg and the little boy 2.5 kg. But they are strong! I put a syringe of 10ccs of formula in the little girl’s mouth and she sucked the plunger to the bottom. She took about 60 cc without hesitation. The little boy struggled a little more but after watching me I wanted the mother to feed him and she struggled with the syringe so he got quite a bit more air.

I spent about an hour there, talking to them about how to mix formula, the need to boil and cool the water first, about feeding them nearly every two hours. Bottles here are completely unrealistic so she feeds them with a cup but they do surprisingly well. I did leave the syringe with them because it was easier to feed such tiny little babies with that but I encouraged her to switch back to the cup within the month.

'

The little girl on my "exam table" (back seat of my car). She is smaller than my medical bag and it probably weighs 4 times what she does.  

I felt at ease upon leaving. This mother is motivated and wants what is best. She now has the resources and I’ll be back soon to check in on them. Thank you once again to everyone who donated formula. It is making a difference to these two!

While I'm feeling convicted to continue to be honest, I have to share with you what God is teaching me. I've been reminded me of how much God loves each person... individually. It is easy for me to think of Ugandans in a lump. To think of them, as just that, THEM.  Especially in Karamoja where I don’t know names or individuals and in my mind they are THEM. But God doesn't see us as THEM. He sees ME. He knows me, knows my struggles, knows what makes me tick. He knows that I’m hopeless without Him.  So He went to great lengths for ME. Earth shattering, mind blowing, willingness to sacrifice for ME.

Then, as He is reminding me was what great lengths He went for ME, for US, He is reminding me that I need to now be willing to do the same. Now that He has me seeing people again as individuals, what great lengths is He calling me to go for one? For that one individual that is so loved by Him.  It makes me a little nervous that this is the lesson that we are working on right now…

So I looked at what I'm doing day after day. I like to teach things that can improve quality of life. I really like to do things that reduce suffering. But more than teaching about HIV or giving malaria meds, I’m here in Uganda to share the life changing knowledge of Jesus’ love. Right here, right now, how am I supposed to be doing that? When was the last time I really shared?  Who today needs to hear? Lord, please open my eyes….

I have to confess I’ve been kind of lazy lately with the blog. I put up a few pictures, talk about my day and call it good. But the intention of this blog is to be honest with what I’m dealing with and what God is talking to me about. I’ve been quiet on this front because honestly I’ve been struggling a little again. 

I'm worried about the future.  I don’t live one day at a time well. I really like to have a long range plan. Even if the plan changes, it’s fine, I just still need to be looking ahead and figuring things out. I knew, while in the process of beginning life here in Uganda, that I would have to be patient, to go slowly and wait on God. But I’ve been here nearly 9 months now! My days are full of it good stuff, and don’t misunderstand me. I like where I am and what I'm doing. But none of it is long term. It isn't stuff that wakes me up in the morning excited about the day or that drives me with purpose.

 I think the reason that all of this is pressing on me right now is that I have a big decision to make. I had a lot of trouble renewing my visa to stay in Uganda last time and I think that a wise move would be before that expires again, in the next two months that I need to leave east Africa. This means a whole range of options. Beckie is heading back to the states for several weeks. While I would love to go “home” for a while this choice is the most expensive and time consuming.  An option on the complete other end of the spectrum is to take a quick flight to Tanzania to visit the International Teams missionaries there for a bit. Or I could just go visit in the Middle East for a little while. I could go to Europe- the reason that I even consider this option is that I’ve always wanted to study more indepth tropical medicine and Europe offers courses specifically for nurses. Maybe this is a good time to work on that. Or, I could take a chance, try to get the renewal, and just stay in Uganda.

I want to begin to work on getting a Ugandan Nurses license. The trouble with that is I have to have a work permit. But the team has to get it's NGO status before I can even apply for a work visa (the whole reason that I'm still trying to use a tourist visa). This NGO thing is proving to be very difficult and time consuming and optimistically- months away. (Probably more like years away.)On top of all of that I have to be outside of Uganda to apply for this work permit. It gives me a headache to even think about.  
All of this means that I have a very few weeks to make a decision and begin to work on something.  I had hoped that while working through all of this to explain it that the best option would make it’s self clear…

Back to Soroti

Barring any unforeseen circumstances, I leave to head back to Soroti tomorrow. I’ve loved my time here with these missionaries. As I wrap up here are a few pictures of the place I’m living. 

The clinic. 

Village outreach

Village outreach day.  Kopetatum was the destination. A lab tec, a few nurses and an educator.  We headed out to give immunizations and check weights of babies, give tetanus shots to pregnant women and do HIV counseling and testing.  We set up shop under a big shade tree, unpacked our meds and supplies then waited for the women and children to come. We didn’t wait long. A steady morning. I saw several more malnourished kids than previously the day before in the clinic. Several women came to the clinic, then left to get water and came back. All of these women with water on their heads were coming from the river for tetanus shots- all were pregnant. 

We witnessed a man coming up to the collection of women waiting for their HIV test results and just pounding on one of the woman, beating her then throwing her to the ground while yelling. Later I got the story that the woman had been told to get water and bring it home before coming to the clinic so she was being punished. Violence against women and abuse is acceptable here. No one in our group really stepped in (a few yelled) but we were all women ourselves. It is hard to watch and do nothing.

Several (more than 50%?) of the infants for vaccinations are brought by their little sisters, most who are barely old enough to go to school- they don’t seem like they should be responsible for a baby.

We were clearly entertainment for the boys and other kids who were happy to take a break in the shade and watch what was going on. A few of these kids had immunization cards.

Leah did some education about HIV then told anyone who was interested that we would test. Several took the chance at free tests. 

Full day

Today was a really cool day. Not in the temperature sense as I’m pretty sure it was easily 110 degrees in the sun with a breeze that felt like it was straight from the Sahara but a full day of interesting stuff. Shortly after morning devos at the clinic we headed out to one of the nearby villages to teach.

We were back at the clinic in time for “mother/baby day” to be just getting into full swing. Leah did some more teaching about when to come for prenatal checkups, when to bring newborns into the clinic (of the roughly 20 women we were talking to 1 gave birth at a clinic, the rest all at home), taking care of yourself, that sort of thing. Then we weighed babies for a while, gave polio immunizations and tried not to get peed on. There was not a single diaper in the place, 40+ babies under the age of 6 months and not a diaper to be seen.  

Quick back up to the mission for a plate of posho and beans for lunch then a walk in the hot sun out to another village. We found a group of women sitting in the shade with their kids and joined them. Then we talked for hours about anything and everything. These women had no desire to be out working in the sun and seemed perfectly happy to be “chatting” with us. Leah brought her language helper and Martha who is also pretty fluent came along. So it was mostly me who didn’t really track with the conversation. But I know they talked about birth practices and material deaths, children born with mental and physical handicaps, marriage traditions and weddings, hair styles, taking care of ducks, and probably a few other things. I enjoyed sitting out in the shade, watching the kids and dozing between swatting flies. 

The "Not Just Posho" song

Here in Karamoja a staple of the diet it posho. This is ground corn flour and water.  The word staple seems to be putting it too gently. Breakfast is corn meal and water that is still a little runny and they call it porridge. Lunch/dinner is cornmeal and water that is so stiff it stands up by itself.  

This picture is posho but it is a little misleading. They don’t use any silverware to eat it, just their hands and rarely do they eat it with anything. That is the problem. They eat just posho.  And it makes them feel full. But that is about all it does. There is practically no nutritional value and surprisingly few calories in a large serving of posho. So one of the things that Leah teaches about is the value of adding other things to their diet. Like eggs, vegetables, beans, or meat. We recognize that these things are “expensive” or hard to get in the dry season but too many of their kids have malnutrition and if they can add just one or two of these things once a week it would make a big difference. So she wrote a song. Practically no one here is literate but songs are a good way to remember things and this group seemed to enjoy learning it and sang it about seven times. It seems like a good start….

1/3/2011

More pictures…

These kids are sitting in the shade gutting the rats they just caught to eat. 

Cattle are a way of life here. Boys from a very young age are responsible to move the cows from the home where they are protected at night out to graze, to water and then back at night. The dry season is only a few months old right now and they still don’t have to go TOO far (though they still walk all day) but as it gets drier and water becomes scarcer they will have to work harder and harder.

This woman is “smearing “. This particular activity is done periodically around homes here to keep the dust down and keep the home cleaner. Ironic because it consists of smearing liquid cattle sh*t around.  But somehow it works. It bakes hard in the sun and is much nicer to sit on than the dusty ground which if not smeared is hard to sweep so often has chicken, goat and human excrement and increases the risk of all those pesky parasites that tend to attach themselves to you here.

This man is grinding leaves that are similar to tobacco.  One of the few jobs that I saw men doing. Most of the work around here is considered a woman thing. Anyway, they grind it up, mix it with stuff like hot chilies or ashes from the fire and sniff it.

Homes in this part of Karamoja are slightly different than in other parts of Karamoja but one thing is pretty consistent- they are hard to get into. They do this on purpose because so much of their time is consumed with keeping enemies out.

This is the season for building homes. It is far too hot and dry to be trying to grow anything right now so they take this time to construct new homes or repair old ones. 

New Year's Day

On the first day of the new year we went to check out the local party scene to see what was happening in the neighborhood. The Karamojung dance to celebrate and there we out in their dancing finest on the first of the year. They chose their brightest colors and put on practically every bead they own.

 

Young men try to jump the highest to impress young women. 

They jump, sing and clap for hours. But mostly it looks like standing around talking. 

I’ve heard that the ostrich feather in their hats means they are available.

The Karamojung believe that all the cattle on the planet belong to them so they have no qualms with stealing them from others. And cows are currency here. And bride prices can be many, many cows for one girl. Where I'm going with all of these facts is that we have been told that there may be an increase in raiding over the next few weeks as after this big dance, young men will be approaching the families of young women to buy marry and there aren't enough cows to cover the costs right now. So the warriors will be on the prowl. 

How was your new year's party?