Saturday, June 30, 2012

Visiting Ngora High School

Picnic lunch with lots of food. 
I took Betty to go visit Abella at her boarding school on visitation day today. Abella’s older sisters also wanted to go and cooked a big meal for her. While at school the students get posho (corn meal) and beans twice a day 6 days a week and a small piece of meat on Saturday. That is it. No snacks, nothing else. So visitation day is a chance to fatten your child back up and give them a day with their families. I’m glad that Abella’s sisters took the responsibility of cooking, I just had to drive.

Betty and Abella wanted to send Beckie (who is back in the States right now) an e-mail.  It took them quite a bit to compose it but it was good to see them working together. It was a nice relaxing day for me and I know they also both enjoyed it. Only 6 more weeks and Abella will be back in Soroti with us.  

Friday, June 29, 2012

Immunization day at Obule Heath Center

Back on Monday the nurse asked if I would help with immuization day, and sucker that I am, I did. Whoa! The nice little, mostly quiet, clinic was transformed with screaming babies. Between the two of us I’m pretty sure we immunized nearly 50 babies.  Near the end I paused long enough to take a picture of the few who were left in the “waiting room”, which is also the veranda outside the clinic. 

Here is a picture of Lucy, the nurse who is the only one there when I’m not. Lives there and works 24/7.  She is looking up mixing ratios and drawing up a batch of immunizations. Most of what they receive comes powdered so they stay without refrigeration but then need to be mixed before we can give them. Most of  the kids who come have a card that tells us who is due for what, but a few mothers have kids and not cards, or vice versa  in two cases. (In the mother’s defense- they can’t read and have to remember which child is due and brings all the cards not knowing which card is for which child but when you have 7 or 9 children and bring the three you think need you may miss one or two.) There was also one case that as I write it now isn’t as funny as it was after 20 children and a busy night shift but at the time it was translated for me I almost fell off my chair laughing. A mother sat down with her baby on her lap and handed the nurse the card while I started to record in our log book. Then Lucy started going on pretty rapidly in Ateso and the mother got a bit worked up and handed me the baby and quickly left.  Lucy told me she left a child at home who also needed injections and would come back. So, with the baby on my lap, we called the next family in. In about 20 minutes she came back with the child she forgot- turns out it was the twin of the one I was holding.  Oops. 
Fun day but I’m glad I won’t be doing that again in the near future. 

Wednesday, June 27, 2012

Evalyn and Eunice

I only had two patients all night. But Eunice needed care on the hour and Evalyn on the half. Both are one month old and each weigh barley 1 pound. They need to be fed hourly via tube, vitals, meds, IV for Evalyn and PO for Eunice. Eunice weighs 1700 grams and technically hasn’t hit her actual birthday yet as she is 4 weeks old but I think she was at least 6 weeks premature so she should still be in the womb. When I came on board with her care two days ago her abdomen was horribly distended so she was changed over to only IV, no tube feedings (she doesn’t have the energy to take formula from a bottle).  Tonight’s shift she doesn’t have IV access anymore and consequently is really dehydrated. But her belly is soft. So we’ve been trying 10 mls of milk every two hours and 10 ml of ORS on the other hour. She seems to be tolerating as long as we go slowly but she still looks really dehydrated. Also she cries every time I put anything in her stomach.  But she isn’t vomiting and her belly is still soft.   
Eunice's initial assessment
In the incubator
Then there is Evalyn. She weighs 1500 grams but is losing weight. She is on 5 ml of formula by tube hourly but has diarrhea several times an hour. So she is getting 15ml/kg/hr of LR. That is one drop every 15 seconds. I’m not sure I’ve ever watched a drip rate that closely before. (No pump or burette for my nurse friends). She doesn’t maintain her own temp and only have one incubator so we use hot water bottles under her blankets but that means we need to take her temp often to make sure she isn’t too warm or that the bottles are getting too cold. And every time we try to change her diaper (which is often) her body temp drops and we have to wrap her back up.
Mdnight meds
Both have to stay under mosquito nets as the bugs are really bad and even the thought of malaria could kill them.  And both are on abx though I don’t understand the rational for the specific meds they are on. I hate giving but I still have to follow their orders. 
So that was my night. Lots of diarrhea, tiny IV checks, NG flushes, hourly vitals and I’m happy to report that they are both still alive and kicking.

This are pictures of a chameleon that lives outside my kitchen door. I worked a 13 hour night shift at Amecet last night. I'm sure I'll have some great material but first I need to recover. For now, all you get are chameleons.

Tuesday, June 26, 2012

Obule HC II

I was working out in Obule Health Center again yesterday. Word has finally gotten out a bit that I’m there so we were busy. For my nursing friends I wish I could explain what this is like but I’m not even sure how.  My day usually starts getting a brief review of what is going on in “the ward”.  This is just a small cement room that has 4 beds but when full usually sleeps between 8 and 12. As it is malaria season the ward is pretty often at capacity. Women, children, men, everyone sleeps there. If it is a child that is sick the mother sleeps with the child in the bed and usually also at least one sibling who is too young to be left at home alone. If it is a woman who is sick her caretaker, a sister, mother or aunt, sleeps with her or on the floor nearby. If it is a man who is sick his wife sleeps under the bed. If I arrive early enough and people are still sleeping it can take me a bit to sort out who the patients are.  And no one has a chart or anything to help me out. Because the sole nurse lives on the clinic compound she is able to keep track of everything. The problem is now that I’ve volunteered to help her out she often takes the day I’m there off and uses the few free hours to go to town. As she is on the clock 24/7 I really can't blame her. So the patients just tell me what is going on. Who has started treatment, how many doses they have received, when they are due for more fluids, that kind of thing. Anyway, after the ward I head to the next building where there are usually a few patients waiting to see me. Yesterday, there was an I&D of a hand waiting and a little kid with a pretty clear otitis media. But it got more complicated from that point on. The next was a young child, feverish with a mother who was insisting it was malaria. Up to this point I’ve been insisting on a positive malaria test before I’ll agree to treat because EVERYTHING here is called malaria and treated with quinine. For example- you stubbed you toe and fell then two days later your knee still aches? From the fall? Can’t be! Must be malaria! Two doses of quinine later (also two days later) and you feel much better. See? Must have been malaria, the quinine worked. Anyway, back to my young patient. I tested for malaria- negative. Then the mother told me that she’d given two doses of quinine already.  Back on Saturday. If it really was malaria, between now and then he should have received 6 doses and still been under treatment. But what she gave was enough to give a false negative test but not treat the disease. IF the child even had malaria-I wasn’t convinced. But untreated malaria in young kids is a killer. So I had to give something. But with lots of teaching to the mother that partial treatment is really a bad thing.
On top of everything else mondays are also antenatal days so I had several pregnancys waiting. I’ve learned over the past few weeks that women don’t really want to come to receive antenatal care but as I’ve been talking to women I’ve been encouraging them to come. The government of Uganda says they give free mosquito nets, tetanus shots, iron and folic acid supplements and malaria treatment to pregnant women. I’ve yet to see the clinic have those things to give away but I guess because I’ve been talking about it people thought I was going to provide. So women came yesterday. I did have a little iron and folic acid to give but not much and the clinic did have enough tetanus for all but I was told by the lab tec they need to receive 5 injections within the pregnancy. What? These women hardly come once. How are they supposed to come 5 times? And what kind of immunization takes 5 doses within 9 months? And most of these women have been pregnant 3 or more times (most like 8 or 9) so haven’t they received it before? I’ll need to find someone who can bring me up to speed on tetanus immunization in this country.  Mostly I did some teaching and tried to estimate their due dates. They all thought it was pretty funny that I would be trying to figure out when the baby will come. They come whenever they want right?
Anyway, that is enough writing for today. It is a challenge out there but like feeling like a nurse again.  I’m sure I’ll have some more stories next week!
My desk
The pharmacy
I'll try to do a better job next time getting more pictures

Saturday, June 16, 2012

In which I try to catch you up on the past two weeks.

Back in Soroti and discovered that I haven't blogged for several weeks! Where did the time go?! I've been in Karamoja again, had planned to spend the week and come back Sunday after worship but discovered Friday afternoon that I was missing the bottom half of a rear shock and possibly had a broken spring. Decided that I shouldn't drive all that far so needed to find parts and a mechanic, not an easy feat and one that proved challenging.... But I'm getting ahead of myself. A week after I expected I'm back and let me start at the beginning. This trip deserves a play by play.
6/6 Headed up to Kangole. Discovered that sections of the road were a bit nasty. Passed several stuck vehicles but managed. Then found a long section of lots of water.  These pictures are not a river, they are the road.
The white mercedes in the middle is stuck, forcing the rest of us to the sides. The water is  over the tires of that pickup that is trying to pass. 
Notice in several of these pictures you can see the culverts piled on the sides of the road waiting to be installed. 
This is the mess that awaits us if we leave the center of the road because someone is blocking the way. 
In two of the areas buses, lorries, cattle trucks, anyone carrying passengers really, force their clients off and make them walk the worst of it to lighten their loads to try to not get stuck. It doesn't always work...
Even had to wait a few minutes to let this poor guy on his bike get unstuck before I passed through. The large pieces of white are chunks of marble that the trucks have had to dump to give themselves more traction and/or to lighten their loads.   
But I finally reached Kangole and had an hour or so before dark to unpack, clean up and settle in.


It was a pretty low key week after that. Lots of language learning and just enjoying being around Kangole. One morning I went over to the home of my language helper and offered to help her dig her garden. Here is my journal excerpt from the end of the day:

6/9 What a day. Worth firing my computer up for at the end of it. I’m in Kangole and my day had nothing specific scheduled. I headed over to the house of my language helper and brought my hoe because it is the season of cultivating and it seems only fair that if I take an hour of her time I owe her some digging. I found her and her daughters and her granddaughters preparing to go to their field. Which is different than the garden. The garden is near the house, small, and has a variety of things in it. The fields however will be a lot of one thing and who knows how far from the house. Loving the idea of a little manual labor and a physical challenge instead of the mental one of just sitting and learning the past tense form of "fetch water" I told them sure.  45 minutes later we finally reach their field.
I’d like to paint a bit more of a picture for you. 9am. Sun already high in the sky. Maybe 90 degrees already. Me walking along with a 10 pound digging implement on one shoulder. EVERYONE we pass doing a double take of this white foreigner heading out to the fields. But apena. (Means: come and we go) We arrived at the field to find several children already busy working. Turns out they’ve been at it for two hours already. The field needs to be turned over and have the biggest weeds and thorn bushes taken out (the smaller ones get to stay). So, I took my place in the line. (In this picture my spot is the hoe that’s just sitting there.)
And even though these kids had worked two hours already they worked me under the table. As a matter of fact, of the only two I could keep up with one was 6 years old and the other was 68. Even the one with the baby tied on her back worked faster than me. Though when she had to stop to breastfeed I could catch up.

Our  first break time. After three hours of working, when I could have really gone for ice cream, or just a cup of cold water, turns out we get a piping hot mug of pourage made with a K-jung favorite, sour milk. Refreshing! The kids sucked theirs down. I had to work a bit at it. When we finally had the whole field ready for seeds we could start to plant. The kids paired up and one would chop a hole and the other dropped two peanuts in. Then the next pair, chopped a new hole, using the dirt to cover the seeds of the first pair. And so on for all 8 of us. Really very efficient. But don’t slow down or you will be run over by the next pair who is sure to be faster than you. And don’t run out of seeds or while your partner runs back to get more or the next crew will be filling in your seedless holes. And don’t swing weakly so that you have to swing again as you will hit the head of your little partner who has already bent down to seed the hole as clearly his former partner never was tired or weak.
These two were as slow as me and my partner and I when I had the hoe and their combined age was 13. 
This was the pair to beat as we raced. 
Our second break at 12:45 with the sun beating down, we are all sweaty and filthy, and finally they look tired too! But there is no shade to rest in.  Early on as I flipped over sod a little field mouse came out of it. As he ran off the kids started screaming at me. I soon learned that I was supposed to beam him over the head so we could cook him up afterward for a snack with all the other little field mice that we captured. Now I know. I had to turn down their offer of sharing with me when they started to build a fire.  I can’t remember my excuse but I’m sure it was a good one.
This was my cut of the spoils
About midafternoon they were finally calling it a day so we left most of the kids there in the field with their rat nuggets still on the fire and we headed back but by then it was an hour walk. I needed a cold shower and some shade. And some substance to eat that didn’t include sour milk or mice bits.
The ones who opted out of the post snack
headed home.
Unfortunately my day went a bit downhill from there as I got back home and it was pointed out to me that I have a very broken shock and possibly a spring too and I really shouldn’t go back to Soroti until that is fixed. Kangole doesn’t have a mechanic or any place to get parts so Monday I’ll have to head up to Moroto to see what can be done for it.  I guess I'll be staying a bit longer....


6/11 With the help of Val's driver and a local handyman we found a mechanic AND  the necessary parts in Moroto on Monday and he restored the truck to driving condition. It was really too late in the day to consider heading back to Soroti so I was quite content to sleep again in Kangole. Val (as if you wouldn't know who she is- info here)  was in Kangole also and talking of getting out to Nakayot. This is the peace village I spend most of my time but the road has been impassable since early March. I've wanted to go out but knew I wouldn't make it. So seeing how she was confident I decided to stay a little longer to join her. On wednesday morning we packed bags, food, seeds, medical supplies and as many people as our trucks would carry and headed out. The road was terrible.

Members scoping out the "road" ahead before determining that we couldn't pass the last 20 km without getting stuck. 
Murrm piles have been put down months ago with the intention of spreading but haven't actually been spread. So the center of the road is blocked. Then the rainy season came leaving deep sticky mud on both sides keeping us from using the "shoulders".
Digging and spreading the murrm to give us a place to turn around after we determined there was no way through.  

So as Val was determined, there is another road that she thought could be passable but it goes back out and around the mountain and back down to the village.  I'm happy to write that after 3+ more hours of driving we did finally get there. And we passed through some of the most beautiful landscape in Uganda ( though I may be a bit partial).  At one point the truck stopped suddenly and we picked up a 15 pound turtle from the grass who became lunch the following day.  

A food that comes in its own pan. Already on the cooking rocks to keep him from "running" away.
The end result. Yummy!
So we were extremely happily received in Nakayot and spent a full two days there. There were planting projects and agricultural teaching, seed loans, community meetings and lots of medical care. We stayed two nights in Val's hut with the local critters. We guessed with the termites in the poles of the roof that we could hear eating all night long, the cockroaches in the floor, the spiders in the thach, the weevels in the rice and beans, the rats looking for anything they could gnaw on in addition to all the other uncountable critters and creepy crawlies there we hundreds of thousands of us all living under one roof. Heart warming isn't it? 
Anyway, friday mid day we packed up and set off between the mountians again. We passed Nabwal (the other peace village) and stopped to greet everyone there and also distribute more seeds there then finally headed back to Soroti. The drive was mostly uneventful and my bed felt REALLY nice last night. And speaking of bed I hear it calling me again! So until next time...

Friday, June 1, 2012

Two prayer requests

One evening in Kangole as I was walking back home I found this little guy with a  cool "manyata" built. Here there is a big fence that surrounds family homes with the cows and small family gardens inside. This boy had a good representation built with rocks for cows, sticks for people and his little garden drawn inside the fences. 

I feel bad that my last posts have been pretty much just pictures and that today isn’t going to be too much better. I’ve been in Kangole all week and am pretty tired today. I fell back asleep after my morning run and now I’m having trouble getting motivated for the rest of the day. Maybe it will be a “Sabath” and I’ll spend all day in my running clothes (no skirt?!) We’ll see.
A few prayer requests:
I’ll be working one day a week for a while in a village clinic here in Teso. It will be a great learning experience and I’m looking forward to helping the community but am afraid I’ll have trouble, well, conforming. For example: yesterday there were 11 people in the ward receiving treatment. This means IV drip quinine for malaria. It is malaria season so many of those could have been possible cases. But not all. So on top of the fact that there are much better drugs than quinine available for malaria some of them shouldn’t be receiving it at all, because they aren’t malaria positive.  But both the nurses and the patients (no doctor) believe IV treatment is best. So… once I’m in the position to prescribe there what am I going to do? Will you pray for needed wisdom and tact?  I start this coming Monday.
An answer to prayer is that God provided an excellent language helper in Kangole. I’m looking forward to spending more time with her as she is a sweet older lady.  However, learning Nakaramojung feels a bit like wading in wet cement with swim fins on. As God has not yet blessed me with the gift of tongues I need to buckle down and get studying.  I hope to head back up to Kangole early next week.

Women walk everywhere here. Babies tied on, blanket over the shoulder anything on their heads. Just a reminder how nice we have it.