Saturday, September 19, 2015

International Travel

Yikes. So it was a really rough couple days of travel and now I seem to have come down with the flu. I'm sorry I've been antisocial for these first few days back.  I left Soroti on Monday morning on a little MAF flight, got a taxi from Kampala to Entebbe and spent a few hours waiting there, then was supposed to fly out of Uganda at 11:30pm. But there were more than 200 IOM refugees on that flight which between security, immigration and boarding caused us to be nearly 2 hours late.  The flight was terrible. The flight staff had no patience for these folks who spoke practically no English and I'm suspecting most of them had never been out of their villages or refugee camps before. I was seated next to two little boys who spoke a bit of Swahili and who thought their parents were on the plane but weren't sure. They were very overwhelmed. One wet themselves because they didn't know there was a toilet on the plane. They were normal kids and 9 hours of sitting in a seat is tough even when you have your parents around. Harder when you a left with strangers in a very strange place.
Because it was an overnight flight we should have been able to get a little sleep but meals took FOREVER to distribute and the overhead lights weren't turned off until nearly 3am and were turned back on a 5am for breakfast. The flight was very hot and very smelly.  I had a 5 hour layover in Amsterdam but they are doing major renovations on their international terminal so there is almost no seating. Hundreds of people were sitting on the floors between departure gates. The flight out of the Netherlands was a noon and we were supposed to land in Chicago at 4 pm but it was definitely not a four hour flight. (  I think it was a nine hour flight). We arrived in Chicago nearly an hour late and between that, hours of waiting in immigration, and missing luggage I missed my connecting flight to Grand Rapids.

After re-booking for a later flight I went back to the international terminal to file the report for the missing luggage. Well, turns out it wasn't actually lost, but broken. I waited nearly a hour but finally they brought it to me. The whole bottom of my case was broken out. Now I needed to figure out how to repack it in such a way that I could get it to the domestic terminal (requires a train ride in ORD) and there was no way they would let me check it the way it was. I also discovered at this time that my american cell phone's sim card was no longer working because it had been shut off for the past two years. And pay phones are rather hard to find these days. After less than two hours of sleep in the last 36 hours it felt like an insurmountable challenge to solve these problems. But a 9pm I finally arrived in Grand Rapids. My family was all there waiting to greet me.
I feel like I've done next to nothing these last few days but I'm starting to feel human again and hope to be connecting with all of you soon!

Sunday, September 13, 2015

Wow! It is that time already! I'm tired of saying goodbye and packing. Tomorrow morning I fly out of Soroti. Tomorrow evening I fly out of Uganda and Tuesday evening I fly into Grand Rapids! It has been a crazy few days tying up loose ends, getting coverage for my patients, getting all the animals food or shipping them out (the dog, cat, eleven rabbits, eight chickens and two ducks) making sure everything I pay for has been paid for the next three months (like school fees and VHT wages) and getting the house closed up. I have a few more hours of work left but I am getting close. See most of you soon!!

Wednesday, September 9, 2015


So it is that time again. Election time in Uganda is coming….Actually elections aren’t until Feb 2016 but primaries are soon and papers are reporting that there are almost two dozen presidential candidates that have submitted nomination forms. This country tries to be a democracy but has a history that only includes one truly “free and fair” democratic election.  (This was in 1996. Museveni initially came into power in 1986 through armed conflict and stays in power by changing the constitution to suit.)   Mostly coups or rebellions have been the means to become a new president.
Today Mbabazi (the Prime Minister until 2014) tried campaigning here in Soroti. I don’t know if it was a planned thing or not (I hadn’t heard anything about it) but the police got all upset and forcibly removed him from the open park in the town center. Back in 2005 laws were put in place making it increasingly difficult for opposition to hold any rallies or anything that could be construed as political dissent of the current president. People got really angry and there was a good sized mob in town. I’m not exactly sure what happened as I cleared out as soon as the parade passed (I love that this city can close streets and have a parade anytime it wants, without any notice, on any day of the week ,at any time of the day, marching bands included.) but later in the afternoon as I skirted town to get to the hospital it was clear that things were escalating. Tear gas was being fired into the crowd that formed outside of the hotel that Mbabazi was in. Most of the protesters were unclear if his own security had locked him in to keep him safe or if the military had locked him in to keep him quiet.  But they felt the need to light piles of tires on fire to make a point. Though, when I asked, protesters weren’t exactly sure what their point was.  Around this time I was drawing far more attention than I wanted so decided that I really didn’t need to see my patients again this evening and decided not to push through the crowd.
photo credit: Red Pepper News
I really hope this isn’t a foretaste of the political situation of the coming months….

This makes Ugandan history as clear as anything else  if you are interested.

Steven update

Sarah and baby Steven are continuing to improve. She is still quite anemic and her incision is healing more slowly than I had expected but otherwise she is doing fine. He is taking about 20 ml of milk every two or three hours without too much challenge. We are still having to tube all of it but will try breast feeding again soon. He is still often too cold and O2 sats aren't always great but he is holding his own. We have planned a "meeting" friday to make a plan how to get them home. The medical staff are afraid she can't care for him well enough. I don't feel like we even have anything to discuss until he starts putting on weight so we'll see how things go. 

Monday, September 7, 2015

I promised more pictures...

This is Whinny's little baby boy. He still doesn't have a name but that is normal and he will probably get his name after he meets his grandparents and extended family. Both mother and baby are doing fine and I expect them to head home tomorrow.

(I love that he is bundled up like it is 50 degrees. I would like to point out that is is easily 90 degrees in the hospital when I took these pictures and warmer outside in the sun.)
Sarah and her baby boy (possibly to be named Steven, it is still under discussion) are struggling a bit more. Sarah is discovering how hard it is to take care of a baby with her handicaps (on top of the pain of c-section) and expressed a lot of frustration today. She is also trying to hand express her milk into a cup and that is not too easy to do. I'm trying to get her a breast pump but this is rural africa...
Her little baby is also still struggling. His breathing is much improved and he can maintain O2 sats above 88% on 2L which is much better than initially. His work of breathing is still significant though. He also has lost almost 200g of weight which isn't completely unexpected but is more than 10% of his initial weight in two days so we have to get that to turn around. He weights almost exactly 1kg right now. 

This is Dr. Elisabeth, a pediatrician and I'm extremely grateful that she works in Soroti now. We were having a discussion today about how many weeks we actually think this little guy is. I've been using the date that Sarah thinks she became pregnant but Elisabeth pointed out that people rarely know the actual date and to prove her point she asked Sarah what day today is and Sarah was pretty sure it was September but wasn't positive. Elisabeth thinks the baby is actually nearer to full term but is so small due to IUGR because of the mother's extreme handicaps. She pointed out that his lack of lanugo and descended testicles means he is full term. I tried to argue that his hypoglycemia, inability to maintain his body temp, abnormal breathing and decreased oxygen levels all indicated he was several weeks early She said these were related to his low birth weight, not his age. Anyone want to weigh in? 

Sunday, September 6, 2015

baby boy

Update: So everyone made it through the night. Winny and her baby are doing fine. She is up and moving around. Baby is suckling and things look good. Sarah is still having a hard time shaking off anesthesia and is hypotensive this this morning. But wants to eat and is headed the right direction. Baby boy however is still struggling.  Now made worse by the fact that the hospital doesn't have power which means his incubator isn't keeping him warm and the oxygen condenser isn't giving him any O2.  (I was told someone went to get fuel for the generator so hopefully that will be remedied soon.) I seem to be the only one concerned that he is extremely tachy and hasn't yet urinated. I had to wake up the nurse when I arrived to point out to her that every alarm in his room was going off and I never did find the doctor. I know I just have to put this little guy in God's hands but I am trying not to get frustrated.  I want to be able to say at least we did all we could. Please keep praying.
I know this picture is pretty much useless but I was working by lantern light and I didn't want to open his incubator and let any of the remaining heat out. So all you get is his hat and one little arm. I will try again later.

Saturday, September 5, 2015

Prayers please!

This is going to just be a quick post because I want to grab a few hours of sleep before heading back to the hospital but I want to ask you to be praying for some of my patients.
Ajiko Sarah (the physically handicapped pregnant girl) went into labor today. This is six weeks early and four weeks before we planned to c-section.  But now she has a baby boy. He weighs 1180 grams (2.6 pounds).  He needed some serious resuscitation in OR and still isn't doing great. At least they are in a hospital that has an incubator, oxygen and a doctor that will at least try. Sarah is having a rough time too. She lost a lot of blood and is not going to get any (that story is for a post when I have more time).  She also had general anesthesia because there was no way to give a spinal with all of her handicaps and she didn't tolerate that very well.  So at the moment I would say she is stable but far from out of the woods.
In a weird twist of fate one of my other high risk pregnancies decided to pick today to go into labor also. So we did the two sections back to back. Winny (I delivered her first baby- story here) wanted to be a v-bac but that clearly was not going to happen. She was having significant late decels. So while trying to prep Sarah for OR I was trying to do frequent FHTs on Winny. (They don't have any continuous monitoring. They just have this fetoscope. They were extremely impressed when I pulled out my doppler and recommended we use that.)
Anyway. Winny and second baby boy are stable. Her baby is full term and normal sized so I'm not too worried about them. It just made the evening quite a bit more complicated. Pictures, update and the details of the story tomorrow.  

Thursday, September 3, 2015

Babies, babies, everywhere!

My camera is full of baby pictures! I love this newest aspect of my job!

My favorite TBA. The women seem to really like working with her too. 
More twins
One hour old! 
This poor kid spent a long time coming and ended up with a rather pointy head.   
First bath!
How excited is this father?!
Ready to take on the world.