Friday, November 30, 2012

Learning stuff in Kampala

So were pretty sure we’ve learned Abraham’s diagnosis (G6PD deficiency Pub Med article here if you want more info) but more about that on tomorrow’s blog. Today, I want to talk about the other things we learned while in Kampala. Abraham learned about watching movies. He saw his first one last week- I chose Lion King. He was so into it even though he doesn’t speak a word of English. He was dancing around to all of the songs. His father learned about television and maybe more fascinating, the remote. In the guest house there was a TV with 3 channels and we rotated between those three over and over and over and over again.  Rhoda learned about skinny jeans and wanted to know how they can be comfortable. I told her they are not comfortable but that isn’t the point. She also learned about Ramón noodles and wasn’t overly impressed (as someone who spends HOURS a day cooking I couldn’t believe she didn’t like a 3 minute meal!) but Emma loved “that thing that is somehow like rice”.  Abraham learned about mannequins and finds them quite fascinating though is unable to tell the difference between a white person and a mannequin. However, in his defense all of the mannequins are white and all white people look the same. Abraham also had to learn about indoor plumbing and how he couldn’t just go outside and pee whenever he needed. I had to apologize to the others at the guest house several times. At least he is super cute so they didn’t mind much. One concept that I’m sure we have not yet mastered is hot water from a tap. I spent quite a bit of time explaining how to use the hot water heaters in our rooms (you have to turn them on and wait for them to get hot before getting in the shower here) but I guess I missed some key bits of information. One evening, after we had been there several days, Abraham climbed up on to my lap and he was freezing. His dad had just given him a bath and judging by his fingers and toes it was a really cold one. I asked his dad if their hot water had stopped working and he told me no- it was working too well. The water was too hot to bathe Abraham in and he had to use the cold instead.
I’m glad to tell you that my village friends were not the only ones learning things in the big city. There is a huge market, (huge is not a big enough word for this market that stretched for literally miles!) here that Emma and Rhoda had heard about and really wanted to visit but I had never been to. It is called a second hand clothing market but has everything from suitcases and belts to baskets and CDs. I had to wait near the truck for them as I was pretty sure the young men loitering around were just waiting to hone their B&E skills but Abraham and I found a building near where we could look over the market still see the truck. He could practice his stair climbing skills (as he has never climbed stairs before- no buildings in Obule have them) which he did over and over while I tried to capture the vastness of this market with my camera. I didn’t do it justice but I tried.

Each one of those roofs and tarps is a different market stall. 

Another picture taken from our vantage point 

The direction we needed to head after they were done in the market. I needed Valium. 

Abraham chilling in the back of my loaded truck while we waited for his dad and Rhoda. 

Wednesday, November 28, 2012

A taste of real Italian ice cream

So nothing to actually report today from Kampala except that I'm so mad at myself for not having my camera when Abraham had his first taste of ice cream.  We put a small bowl of it in front of him and he tasted it and screwed his face up. Then had another spoonful and tears came to his eyes. By the third spoon he was crying and still trying to eat. We we all laughing! Kids here are so programmed to eat what it given to them that he was trying even though he thought it was so cold it was physically painful.  I took his bowl away and he was just looking at me like he wasn't sure if he was happy or not. Then I handed him an orange instead and got a huge grin. Don't worry Abraham, I got the message: ice cream is not your thing.

Tuesday, November 27, 2012

A little glimpse of the system that is IHK (International Hospital Kampala)

I’m at what I consider the best hospital in Kampala (this trip has not yet changed this opinion) and a few things still knock my socks off. AS we were looking for a place to park, a portion of the lot was unusable because apparently the hospital’s septic system was having some problems. As we passed they were prying the lids off and you cannot imagine the number of cockroaches that ran out. Sick!
We walked up to reception, registered and paid a registration fee. They then determined what kind of service we needed. For example, this time I wanted a pediatrician but was willing to settle for a GP. They said the pediatrician wasn’t too busy so we could do that. Then we went over to the peds office and filled out more paperwork and did an ultra brief triage with the nurse. She then sent me over to the cashier’s office (back down on the first floor) so I waited in line to pay and get a receipt. Then back upstairs because now we could wait in line to see the doctor. Eventually we got in to see her and got orders for labs and radiology. We took the lab requisition slips over to the lab (which is both inpatient and outpatient) where we waited while they filled out the bill which I then took to the cashiers to get that receipt. (I tried to pay the bill for radiology at that time also but, silly me, was told I had to go to radiology first).  While waiting in line there I realized that I wanted to add several labs to what the doctor ordered because I don’t want to be doing all of this again in a couple of days. So, back to the lab to ask them to add CBC and CMP.  They didn’t even hesitate. The doctor had already ordered a Hb electrophoresis, blood smear, and a few other very specific things but I wanted a broader general picture. Back to the cashier with an updated bill, then finally got in line again to have the blood drawn. We were given a card with a # and a date to know when to come back to collect the results to bring to the doctor. Then over to radiology to get in line for another bill with that requisition slip. Then back over to the line at the cashier’s office (seeing a pattern here?!) to get a receipt and back into the radiology line to finally get the scan.
The astounding part of all of this is that if you don’t bring someone with you to do all of this (like I’m doing for Abraham and Emma) then you have to do the back and forth and up and down yourself (it isn’t a huge hospital but it is still a lot of moving around!) like the poor guy who was bleeding from his head behind me in one of the many lines I was in. I’m not a doctor but I still think he shouldn’t have spent hours standing in lines today while losing blood like that.  One other mildly entertaining thing was how often at the cashier’s they couldn’t make change for me. Both of the times that they didn’t have my balance I knew I was coming back so I was OK with it when they just scribbled a note on the top of my receipt that they owed me 20,000/= or whatever.  But it seems a little strange that they really only have one job…
But enough of all that. Back to Abraham. He got his ultrasound this morning (I didn’t stand in all of those lines yesterday. I saved some for today.) We learned that his spleen is normal, or at least as normal as any child who has had malaria a bunch of times. Yay!! But his liver is way too big for a kid his age. This finding really does a number on his differential diagnosis and the hepatomegaly makes me REALLY wish I had added a liver panel to the labs. But now we kick back and wait until we see another doctor on Thursday afternoon.

Abraham enjoying some R and R with is new favorite toy (thank you Elliot for sharing!) at the guesthouse this afternoon.

Monday, November 26, 2012

Abraham in Kampala

It has been a very long day but sitting here at the end of it I’m really content so thanks for all your prayers everyone. For those who don’t know the current adventure I’m in is attempting to get Abraham a legit diagnosis. For a little background (tune out for this next paragraph if you follow my blog regularly), Abraham is a sweet 4 year old boy who has some mysterious issue causing hemolytic anemia that the medical system in Soroti is completely unable to address. 12 times in the past 3 years he has gone to the hospital (many resulting in admission).  Usually there is a diagnosis of malaria but several times I had tested him and already knew that it was not malaria. They always put him on some enormous doses of antibiotics that rarely seem appropriate, effective or age/weight adjusted. They put him on a moderate dose of steroids which makes practically no sense and he has been on it for more than 6 months now. Every time he gets sick he gets a high fever and urinates blood. He complains of abd pain, gets very jaundiced and occasionally bleeds from his nose. This last time he was vomiting blood and needed to be transfused he was so anemic (but the blood bank didn’t have any blood to give him).  They also didn’t give IV fluids causing me much irritation and they upped his steroid dose which made no sense.
So, 6:15 this morning found me packing to go to Kampala. We arranged for Roda, a young lady in the church with fluent English, to come along as translator and Abraham’s father Emma, as his mother has 4 other children to stay home with. Abraham is well at the moment causing us to discuss if we should wait but every time he gets sicker than the last and one of these times he isn’t going to turn around. So we embarked on the arduous 6 hour trek anyway. We arrived at the hospital around 3pm and managed to get into see the pediatrician with only a 1 hour wait. At least she admitted right away that he was a pretty unique case. She ordered labs and an abdominal ultrasound. The labs will take 3 days to get the results but we at least got them drawn today. The ultrasound we’ll get in line and wait for tomorrow.
Emma was last in Kampala as a 15 year old kid and Roda has never been very far out of Soroti. She admitted that she has never used a shower “like this” (with the water coming out above her head instead of in a basin at her feet) until today.  They were all very impressed with the sheer volume of the Nile and ordering off a menu at dinner was surprisingly complicated for the adults. Abraham seems to be oblivious to it all except traffic noise which he mimicked for the entire two hours we were stuck in Kampala traffic today. (There are a surprisingly large variety of horn sounds when you pay attention!) So that was our day. Please keep praying!

Tuesday, November 20, 2012

Writing curriculum

Prayer requests: I’m in the process of writing new curriculum targeting mothers and medical problems their kids have. There are tons of misconceptions and abuse of medications and bad treatments. I want, most of all, for it to honor God and share truth. It needs to address relevant issues but in a way that is easily understood. Sometimes they don’t like what I have to teach because it is different than that they’ve been taught before (like there isn’t a medicine for EVERY problem) but it is really needed teaching. Most of the mothers I’ll be talking to are illiterate so it needs to be visual and simple but also not be superficial and a waste of their time.

Life in Kangole

Several times I’ve done a day in pictures of what my days are like in Soroti but never while I’m in Karamoja so last week I took some pictures to try to give you a glimpse.  
The day starts early and if you want a hot caffeinated beverage you need to start a fire.
Getting water for the day takes a while so leave yourself some time.
The hut seems to collect dust and bugs like it is grass thatched (which it is) and I have to do laundry at least twice a week (which means an additional trip to the borehole) so often the cooler morning hours are spent working. 
Laundry with my home behind

Got to store up a few solar hours for light later.

Fill the water filter to have clean water for the day. 

Generally later in the morning I have all my other things done, and I head the half mile to my language tutor’s house.  She is always working when I arrive and I sit while she works and learn vocab, verbs, and various other things you have to try to comprehend while learning a new language. Occasionally I attempt to help her with the work to get a break from thinking. 
When I tried this they all laughed at me and I hurt for 3 days so enough of that.
This week's work was gathering sticks to build a shade for their yard.
This is their current shade structure until the new one is constructed. 
Most days, after my language lesson, I spend a few hours working in the CLIDE office on things, or try to do computer work, but to be honest, some days I just take a nap. Then in the later afternoon I head into the town center or market or visit a few of the church ladies to practice the things I learned. 
Girls in market

Trying to sell the pumpkins they grew. (I know the word for pumpkin now!) 

Lots of activity in the Kangole market.
Could get a new "eburangkit"
Talked with these girls for a bit but only after I bought something!
Then a few hours to make dinner and when the sun sets I read or study a bit. That is it, pretty simple life for now. As my language learning gets more advanced I’ll have more ministry activities to do but I’m going slowly for now with lots of learning. 

Monday, November 19, 2012

Hospital- a picture is worth a thousand words

Several weeks ago I talked about hospital pictures. Finally managed to get a few. Sorry about the poor quality as I was trying to be really subtle and not look like I was taking pictures for the most part.

This is outside the woman’s surgical ward. Make sure you bring someone with you who will watch your baby and fetch water for you.  Some of these patients have been waiting literally days to be seen by a physician.
There are no beds left so this young patient sleeps on the floor. You can’t see in the picture because he is hep locked but his IV abx treatment is just tied to the side of the neighboring bed.
This is Abraham (the child I was visiting) and his bed mate, who his family didn’t know before yesterday! Their charts are there above their heads and if you look closely at the bed behind Abraham’s you can see there are three patients sleeping in it and two moms sitting as there are no chairs in the whole ward.
Abraham finally stopped vomiting blood on Friday and was discharged Saturday but after being in the hospital for seven days never received a diagnosis (and was only seen by a physician 3 times and had labs done once).  Next week Monday the plan is that Abraham, his father Emma, a member of their church (for translation purposes) and I will head to Kampala to attempt to get some real treatment for Abraham's condition.  I'm learning that many children, boys especially, between the ages of 3 and 7 are dying in rather high numbers due to this unknown condition. It seems that 7 did last week while Abraham was in the hospital. The doctor told me that they really started seeing it in 2008 and have not yet determined a course of action. He has been on prednislone for nearly 4 months now but it isn't changing anything. So feel free to pray for us as we go that I won't lose my salvation over frustration in a ridiculous medical system. (Remember this and this?)

Friday, November 16, 2012

Back in Soroti again!

I've been living the nomadic lifestyle the past few weeks and have had to go without either power for the computer or internet for most of that time (generally if I had one I was guaranteed to not have the other). I was in Kangole a week then with my Ugandan coworkers at their annual planning “retreat” (though I use that word loosely).  I’m finally happily back in Soroti but only through the holiday then I’ll head up to Nabilatuk and the following week I’m teaching in Amuria. I know for most of you these place names mean practically nothing so I’m sorry but the long and short of it is I've not been around home base much at all.

God has been doing quite a bit of teaching in my life lately (I suspect it has been because without computer I’m less distracted!) and I hope some of my next blogs will reflect that. But in the meantime I just wanted to update that I’m still alive, experiencing life and generally falling further and further behind on the e-mails I need to respond to! (Sorry to anyone who e-mailed and I haven’t responded to.  I’d like to promise it is coming but don’t hold your breath.) More to follow soon!

Monday, November 5, 2012

Dumpster Diving Ugandan style

The idea for this topic has been rattling around in my head for a while but yesterday I saw something that tipped me over the edge and hence this post. 

There is a big old nasty dumpster near my house that "collects" garbage but there is no city garbage collectors so no one ever empties the dumpster.  It is just a huge foul smelling pile of refuse and people keep putting stuff in it even though it most likely will NEVER be emptied.  It is beyond overflowing and the trash is at least 3 feet deep in a 3 foot radius around the dumpster.  A few months back I saw two dead baby goats in the dumpster just to describe how nasty this pile of trash is.

Chickens looking for breakfast
All the time I see animals eating out of it. First thing in the morning are the chickens and turkey. Later in the day it is the goats mostly but occasionally sheep and once I saw a cow.  For a while there was always a whole family of little ducks but I haven't seen them in a while. Probably died of toxic poisoning.  

Worse, daily I see people rooting through it. Now, my neighborhood is poor (along with the entire rest of the country) but not THAT poor. My mom made the joke that it is not a trash heap it is a recycling center and initially it was funny. My trash is your treasure right?  But the more I ponder this the more I get angry. There is NOTHING eatable in there- no one throws away food here. Nothing wearable- they wear things until they are literally rags. Nothing usable.  What are they looking for?!? In the slim, off chance, that potentially they find something that someone (accidentally?) threw away that could still maybe be used, they have exposed themselves to all sorts of nastiness in the process.  Because I have not yet gotten to why I'm writing- yesterday I saw someone tearing open a red bio hazard bag to see what was inside. 
Now I've been in this country a while now, in hospitals and clinics, both government and private and have never seen a biohaz bag being used.  Ever. But I did see them here on the news when Ebola was confirmed and again this month when Marburg disease killed 9 people. Now, I think the likelihood that something in that bag was actually as labeled is practically nil and I'm sure that is what this individual was thinking BUT IS THAT A RISK YOU ARE WILLING TO TAKE?!?!
 Let's say someone finds batteries that are nearly dead but not quite so they got a couple of uses out of their flashlight. And then spent two months suffering from the diarrheal diseases obtained from standing this nasty refuse pile. 
Or save some time by not taking their animals out another half mile to real grass and instead let them eat out of the dumpster and suffer for the rest of their lives from the liver parasites they will get from eating the infected animal. The medical nastiness could go on but I'll leave it at that. 
Some might try to defend my neighbors by saying they don't know. But even if they don't know the name of "Echinococcus Multilocularis" or how it will affect the body, what thought process has to go on to allow digging through this trash heap to seem like a good idea?
OK- I'm done ranting for tonight. Have a good day. 

At the hospital

There is nothing like sitting for two hours at the government hospital to get the blogging juices flowing. Little Abraham  (4 years old) is really sick again.  Teammates Ronnie and Collin transported them into town this morning because he was urinating blood and vomiting and too weak to ride the 10 kilometers on the back of his dad's bike (which is what they have done in the past).  They were dropped off at the hospital around 11am. When I arrived at 2pm to see how they were doing they still had not seen the doctor. Most of the time I don't like standing out as the white foreigner but today my joining them on the bench, packed with waiting pediatric patients (we were not in an ER, we were just waiting to see the pediatrician who never did show up) brought the medical officer over who at least admitted them and ordered some labs. Abraham was really lethargic sitting on his dad's lap while the MO did an "assessment" which mostly consisted of him asking what my assessment was. I noticed Abraham suddenly show more energy than he had in hours and though to myself: he's about to puke. Yep. All over the MO. I think both of us felt better.
Anyway, we went over to the lab to get a malaria test. I was super impressed to see them pull out a rapid test (actually MORE accurate here) but then when I watched the tec obviously not know where to put the blood and then not have any reagent and try to use NS.... Malaria negative. He told me the results as though he had no idea that the test he had done was totally worthless. He probably didn't know. Then we headed back to the ward and Abraham's father wandered around looking for an empty bed to put his child in. I didn't know this yet about the hospital but evidently after you are admitted you just go looking for your own bed. Abraham is currently sharing a bed with an other little boy who doesn't seem too contagious. We didn't find an empty one and that is better than the floor,
Anyway... I'm not even sure where I'm going with this post. Please pray for this family as clearly their only hope of health and healing is in Jesus.

** And for something to look forward to I am going to try to get pictures at the hospital when I go back to visit again tomorrow. Am currently cutting a lens sized hole in a box of juice to carry inconspicuously ... this could be interesting.