Thursday, July 26, 2012

Easiest delivery ever!

A few of the other kids cooking as their mother was occupied
Ronnie (fellow teammate) called me around 1:45 this afternoon asking if I wanted to go deliver a baby. As my things left to do for the day were a pharmacy order and a grocery run I thought her idea was more fun so agreed. I quick grabbed my bag, picked up Ronnie and headed out to Obule. Rose is one of the ladies of the church I attend and I've been watching her get bigger and bigger for several months now. Honestly, I expected her to deliver weeks ago but she refused every time I encouraged her to come to the clinic on an antenatal day so I was really just guessing. I knew she wanted to deliver at home and as this was baby number 8 for her I really had no way to argue against that. When we arrived out in the village today and walked into her hut she was sitting on the floor, pretty relaxed. She looked a bit uncomfortable but was talking with us, with her husband, with her mother-in-law and generally giving very little indication that she was in labor. I have a very hard time understanding her English and I wanted her to know I was willing to help but yet also just wanted to stay out of her way and let her labor as she was most comfortable.  I asked a few questions about how long she had been having pains (contractions)- "since 10 am", and if her water broke- "not yet" but really got the sense she had in well under control and didn't need or want help.  She told her mother-in-law that she wanted to walk around. Ronnie and I sat on the ground outside as she headed off in the direction of the latrine. I few minutes later she went back inside but we heard the water from the basin splashing around so didn't go right back in to give her some privacy. Just minutes later we heard a baby cry! I jumped up and went in just in time to see the grandmother ease a good sized boy down to the ground. While Ronnie hunted through the med bag for my receiving blanket, I tried to keep the baby out of the massive puddle of amniotic fluid that was quickly turning to mud on the floor of the hut. The cord was still really short so I quickly tied and cut it so we could get the little guy up to his mother's chest. (BTW- hemostats are so much nicer than trying to tie that slippery cord with string!) The grandmother helped Rose get into a squat to deliver the placenta while Ronnie and I rubbed the baby off and tried to encourage him to clear his airway a little. He really looked good even though he had no desire to cry so we just held him to help him warm up. He was by far the most alert newborn I've ever met! 
10 minutes old
The placenta took a little while but finally came and Rose began to move around and clean up. It still amazes me that these women are so strong. Within 30 minutes she was sitting up, interacting with her other kids and getting on with her day. 

Rose on the left having a cup of tea, baby boy being held by his older sister. 
Mother-in-law (never did get her name, Rose was just too fast!) holding the new baby while Rose rested for a few minutes in the background. 
Praise the Lord it could not have gone any better! All seemed to be doing well and I was back home less than 3 hours later. If only they were all like that! 

Tuesday, July 24, 2012

In which I attempt to be a qualified prenatal nurse, part 2.

*Out of chronological order as this post is a continuation of the story from two days before. (7/26/2012)
Spent several hours yesterday at the HIV clinic with Esther and her mother Mary. It was good to get to know them a bit better, not so good to sit on a terrible bench in the waiting area until my back ached and my butt was numb. During the waiting I learned that Esther had meningitis around 6 years old and has never been mentally well since. We talked of the father of the baby and how he has "run away" and is refusing to pay anything for impregnating Esther.  He also has abandoned two other children with his wife when he ran away. Clearly he is going to be no help whatsoever.
When we first arrived we got Esther enrolled in their HIV positive mothers program and then got her blood drawn for a CD4 count. Hours later we were finally called in to talk with the "doctor." She handed Mary the lab slip, said her count was fine and that she didn't need anything at this time, to come back in 6 months. Wait! I practically jumped out of my chair but on account of my legs being numb wasn't able. "Doesn't she need ARVs on account of the pregnancy?" "Oh, she is pregnant?" Good grief. She is due in three months and big! And we are part of the positive mothers program- that is why we are here! But I learned that as her count is still above 200 all she gets is a daily cotrimoxazole.  Her count is around 550 but a healthy persons' should be 1000 or more so I kept pushing for ARVs but she just wasn't going to get them. I asked if the "doctor" could interpret the ultrasound results for us but she just told Esther and her mother to return the the clinic on the followup date. I explained to her that I wrote that followup date and I was the one they were going to be returning to.  Finally she wrote a referal to Soroti main hospital but as that is where they had the scan done and no one did anything with their case at that time I'm not overall hopeful for their next visit. But I did  managed to arrange for them to come back to the HIV clinic for a repeat CD4 in two months so if she does drop lower we won't lose too much time getting her on ARV's. Anyway, please pray for them. Esther is in no position to care for herself, her parents are both elderly (well into their 60's which in Uganda is not common) and the father of the baby seems like a sleeze bag.

In which I attempt to be a qualified prenatal nurse

Yesterday was antenatal (british way of saying prenatal) day in Obule health center. It is fun to have been doing this long enough now that a few of the ladies’ pregnancy cards land on my desk I recognize my own handwriting (and appreciate my much more thorough notes so much more. Yeah charting skills!) But there is one young mother, Aruto Esther,that really stood out even without my great notes on her case. Three weeks ago she came with her mother for her first ever antenatal check. She has a diagnosis of epilepsy and is on phenobarbital. (I’ll save my medical friends the look up time. Phenobarbital: preg risk class D- known adverse effects in human fetuses) She started the drug a while ago and went from having 2-3 seizures a day to 1 every few months. This seems like really good control and the only other med used for seizures here is thorazine, besides that she told us she is pretty sure she is 16 weeks along so she is well into her second trimester already anyway. I wasn’t going to be the one to take her off it.  While talking with them it became obvious that she has some other mental handicaps also but seemed really sweet and pleasant.  Her mother really cared about her and was clearly trying to take good care of her. After a few other history questions it also became clear that Esther had been taken advantage of. I’ll even go so far as to say that she was raped. She may be physically 20 years old but her mentality is more like that of an 8 year old. The man who impregnated her is known to the family and already has a wife.  This lead to a question or two about STDs and the pt’s mother agreed to testing. As we stood up to leave the consultation room and go to the exam room it was immediately evident that she was well beyond 16 weeks. She measured at 28 weeks. But I couldn’t palpate any baby body parts! I’m not greatly skilled in this area but by this far along I can discern head, butt, limbs and back. However, not on this one. And there were no discernible FHT’s by stethoscope either. (Didn’t have my doppler with me.) As we sat back down to discuss the need to go to Soroti for an ultrasound (few of the mothers here ever get an ultrasound for any of their pregnanacies) the lab results came back. HIV positive. Seriously?! So more bad news, more teaching and encouraging them to go to Soroti also for a CD4 count and ARVs (treatment that can decrease the risk of the baby also contracting HIV).  By then there were 20 other cases waiting so they left and I tried to put them out of my mind. (Without success.) I’ve been asking after them every time I’m back in Obule and yesterday they came back to the clinic to see me. Her mother had found the money for the Ultrasound and they gave me the results. It is amazing how terrible the report is. I quote:
Norm preg 23/40 weeks normal placenta over abundance of amniotic fluid.
End of report. At least I kind of have an EDD (estimated due date) now but, to my medical friends, is polyhydramnios ever benign? What was the point of having them pay for the scan?! Deep breath. They had also gone to one of the HIV resource places but had been turned away as they didn’t have enough shillings. I was under the impression that HIV care was free in the country especially for pregnant women but it turns out it is free AFTER you pay the “registration fees” and pay to have your CD4 results. Then it is free. Anyway, I confirmed that she was still taking the prenatal vitamins I had given her, we gave some malaria prophylaxis and a tetanus shot in case she delivered early at home. I stressed the importance of the ARVs and encouraged them to try again. The mother told me transport was a problem (it is about a 10 mile walk to the hospital) so I offered to pick them up tomorrow.  If nothing else it is a chance to spend a little more time with them. 

Monday, July 23, 2012

Headed to Canaan

I was singing a song in Ateso at church yesterday and was reminded of the first time I sang that song here in Uganda. Now, I understand most of the words but at the time I didn’t have any idea. The music started up, we sang about one verse then as the chorus began, the ladies sitting on the floor stood up, people started picking up their mats, moms tied the babies on their backs, kids piled their things on their head someone even folded up my chair (as the white visitor I was one of the few in a chair) and everyone started heading for the door.  I thought church was over. Turns out the song is about heading to the promised land. Everyone was ready to go! This morning I knew better than to think the service was finished and people piled stuff on their head and danced toward the doors. But I did keep thinking about heading to the promised land. Am I ready to go? Don’t worry, I am not questioning my salvation at all. I have no doubt at all that I’m headed to the promised land after this life. But as I’ve had to think (and plan!) seriously about leaving Uganda this past week I’ve felt an urgency that I’ve not felt before. I’m not ready to be done here! There are still many that need to hear the Truth. Canaan is going to be wonderful and I'm looking forward to it but I'm not ready to go yet. And I want to challenge you too. Are you ready? Do you have something you need to do TODAY? 

Sunday, July 22, 2012

Rain forest

Finally, the long promised rain forest pictures!
Lets start with the butterflies because words can't even begin to describe the vibrancy and variety of their colors. 

The butterflies were more varied and numerous than the monkeys but still the monkeys were more impressive. Mostly they stayed high up in the canopy and wanted little to do with me but I still tried to coax them down.  
Simply called the Red Tailed monkey

Colobus monkeys

Blue Monkeys
Hard to see the forest for all the trees.
I went on an amazing night hike and saw bush babies, flying squirrels, a porcupine and bats that seemed to be the size of cranes as the swooped for the mosquitoes hovering above our heads. But turns out a camera isn't much good on a night hike so no good pictures of the nocturnal animals.
The guide told me there was a snake "over there." Here is a picture with the zoom on of over there as I sure wasn't getting any closer.  We were already 20 feet up in the trees so there wasn't much space to move. Didn't need to have anything feel threatened. 
Nothing like camping in the rain forest out of the back of my truck. 
Not a good choice for a walking stick.
A nice place to swim?


 I'm as impressed by the flora as the fauna.
With all of the drama of the passport visa aside I had a wonderful, restful trip, taking long walks in the forest, and just listening to my creator. I highly recommend it.

Tuesday, July 17, 2012

I won't be packing yet!

Thank you all for praying! I was granted 3 more months here in Uganda. We still need you to be praying for our team with all of our necessary work permits and our needed NGO status as it is complicated and we really want to do it quickly and legally. We are still unsure what the current laws are but were told that they have changed for visas, work permits and special passes.
This all has been a good reminder that our time here is limited and we need to use every minute we are given. It also reminds me once again that there is a spiritual battle going on that we have no grasp of. Thank you for battling with us!
Now, where are those rainforest pictures?

Monday, July 16, 2012

I surrender

Too late at night (or too early in the morning) and I’m still awake…. I don’t really know why. Well, I do, sort of. In a few hours I’m heading to Mbale to try to extend my visa. If unsuccessful, in the next few days I’m going to be packing up and heading back to MI. If successful, I’ll be going back to doing what I do here and heading up to Karamoja soon. As I run it through my head over and over and over and over again, I find that I’m pretty calm about heading back right now. I was not expecting to be back for about a year yet but I don’t hate the idea as I get more and more used to it.  I even find myself starting to look forward to things. And I would stay until the processing of my work permit is finished which is an unknown amount of time but I'd think it would be about 8 months.  On the other side, obviously, I also am pretty fond of the idea of staying here. So why am I still awake with this nervous energy I can’t seem to contain? I guess it is mostly the uncertainty. But, I live in a third world country. Isn’t there always uncertainty and insecurity? Really, why is tonight (this morning) different from any other?
I find myself praying quite a bit since I got back from Kenya.  I want to pray that God just makes everything smooth and the immigration official stamps me for three more months. But a tiny part of me asks why I’m still struggling without the right papers here and why not wait it out in the States? I want to pray for the clear sign to head back, for the chance to reconnect with friends, family and supporters, to be able to fundraise a bit more. But every time, I realize that my strongest desire is for God’s will to be done.  I don’t want to be here or there if it isn’t where I’m supposed to be. I find I’m resonating tonight with the words of the old hymn:
All to Jesus I surrender
Make me Savior wholly thine;
Let me feel the Holy Spirit
Truly know that Thou art mine.
I pray that His will be done. Will you please also pray with me today?

Friday, July 13, 2012

I'm in trouble...

24 hours ago when I was writing this blog post (in my head, as I was in the heart of a Kenyan rainforest and it turns out there are no internet hot spots out there) it was a fun, upbeat post, with awesome animal pictures, funny stories of the random travel experiences I was having, like monkeys in my truck, and it was going to talk of how rested and relaxed I feel. Unfortunately, only one day later it is now a plea for prayer.

While trying to re-enter Uganda yesterday, I requested the standard 3 month visa. I was given two weeks and told this was the new law. I tried requesting more time, pleading, I would even have paid the bribe if the immigration officer had given me the opening but he was having none of it. Not really knowing what else to do I continued home and for the 3 + hours of driving I just when round and round about what this will mean for me and what I’m going to do.

This morning, I still don’t know what the next 13 days and beyond will hold. But I do know that “in all things God works for the good of those who love him and are called according to his purpose.”  Will you please join me in prayer?  I don’t really even know what my next steps should be….

And don't worry- I will share my amazing rainforest pictures soon. They are far too good to be pushed aside by stupid visa posts for too long. 

Monday, July 9, 2012

Here we go again! (The ongoing vias saga)

I've been back in Uganda for 6 months so that means it is time again to renew my Ugandan visa. Which means I have to leave the country. That is the easy part. I also would like to re-enter the country. That is the part that proves to be trickier. Today, I'm heading to Kenya for a forced vacation and I'd like your prayers. I have many other things I'd rather be doing and I'm trying to not be anxious about getting permission when I come back for 6 more months here but I'm a bit worried.
So, here it is, will you pray?

  • Simple exit and re-entry through immigration
  • Good travels with no mechanical problems (as it is a few hundred kilometers on bad roads)
  • A safe place to stay
  • Ability to relax and just enjoy the time away
  • Several sick teammates in Soroti 
  • And next weeks I'd really like to be headed up to Karamoja....
I guess that is it for now. Thanks for your prayers!!

Sunday, July 8, 2012

Update on Eunice and Evelyn

I've been asked for an update on the two little premies I was caring for. These two little peanuts are still fighting but I have to be honest and admit that I'm torn. From the beginning I've been praying for health and strength and honestly, a miracle for both of these little girls.  And somehow, they are both still hanging on. They have had numerous problems, too many to mention. We don't have IV access on either of them at the moment so we are constantly battling dehydration and digestive systems that are just too small for milk on top of inability to regulate their temps, anemia, breathing difficulties and infections. But God has answered and they are still alive.

 So here is where the mixed emotion come in. Yesterday when I was there we weighed them.  Eunice has lost weight and Evelyn has only put on 200 grams in a week. They just can't seem to catch a break. Evelyn has bouts when she gets so tired she struggles to breath and Eunice cries and cries sometimes after we tube her formula and draws her little legs up to her chest like her belly hurts. But, in this country, there isn't anything more we can do to keep them comfortable. Every day we  try again to get IVs in and they have gotten poked more in their very shorts lives than most people ever do. Is it time to stop praying for their strength to keep fighting and instead pray for our strength to let go? I choke up even as I write that but I know these tiny little lives are already in the hands of our wonderful Lord. Why not let them leave these tiny, sick, fragile bodies they are trapped in? Maybe that isn't the right attitude but I can't help look ahead and consider their futures. They are looking at months, possibly even years, at Amecet before they are healthy enough to go. And, don't get me wrong, Amecet is a wonderful place. But it is a baby shelter, not a home. There are staff that punch a clock, not mothers. There are cooks and gardeners but not fathers. They are nearly two months old and still smaller than most newborns. They are most likely HIV positive and have the potential for huge long term medical issues. They don't have mothers who are alive or are in a position to ever care for them so they will go to elderly grandmothers or distant aunts. They don't have safe, loving homes to go back to even if they manage to pull through this. I want them to live and with every fiber of my being I know their precious little lives are treasures and I will do everything in my power for them. But I can't help but wonder if that is selfish...
Please pray for the staff of Amecet as on top of these two the got twins this week who are almost as small who's mother died just a few days after birth. They also got three kids from the police station who were left at the bus park and are so neglected they look like little Holocaust victims. They were in bad condition with parasites, wounds and covered in their own vomit. They aren't really talking by they are estimated to be 5, 3 and 2 years old. Every bed is full and most of the cribs have two.
There is a Canadan nurse volunteering there  who will be working practically around the clock for a few weeks and more Ugandan staff has been hired to meet the needs but that is still a lot of work and emotional strain.