Thursday, May 25, 2017


Even as I look at these I can't believe how much Soroti has changed in the 7 years I've been here. But we have a really nice pool now. Specifically for kids. The students I sponsor have been begging again and they know this is one of the few things I'll cave on because I love to swim too. 

Well, I agreed to take them. Unfortunately there were literally a hundred kid there. Most who clearly had no idea how to swim. Terrifying!

Anyway, here are my eight. 

They all head back to boarding school on Monday. 

Wednesday, May 24, 2017

Following up

Lots of follow ups today.....
On the 8th I was in the midst of a complicated labor when a lady with a snake bite came into the clinic. She had been picking up firewood and a cobra got her on the hand. I went to see how she was doing today and here is what I found. I know it looks a bit gruesome but I'm actually ecstatic how great it looks.  I was pretty sure there was a good chance she was going to lose the finger at least and for a while I was worried about her life. But this is just routine dressings for a long time and eventually she will be back to normal! 

Then little Mary who had tetanus back in December. She is now a healthy kid. She is still the only tetanus case I have had survive. She WOULD NOT smile for me, which is really sad because she smiled all the time in the hospital (once her muscles relaxed enough that it was physically possible) but I suspect she has a really hard life. She is HIV positive and lives with her elderly grandmother who needs her to work too much to send her to school.

Lastly I stopped by the home of Esther and her baby who is two weeks old today. They are all doing fine and the grandmother reminded me that I was the one that first diagnosed her HIV. I did not remember that but I guess it was significant enough that I blogged about it. TBT...2012 and the next day.

Saturday, May 20, 2017


When I want to be there so much it hurts....
My family grew this week and I'm on the wrong continent.  (By the way, I realized these are slightly confusing pictures, Nick and Katie had a baby, not Chip and Susan.)

Thursday, May 18, 2017

Update on Jennifer and Esther

Update on Esther and baby Jennifer. I first wrote about them on Sunday
They were discharged today (still on some valium) so I brought them back home. 

 This is Esther with her first born, Emma. He is four years old.
Grandma holding baby Jennifer surrounded by neighbor kids. 

This little peanut went home today weighing 2.25kg.

Wednesday, May 17, 2017

I had no idea when I took this job how much time I'd spend teaching. And the strange topics. Today, I taught at a parenting conference. I'm perfectly well qualified for that. 
I'm just kidding. I did teach at a parenting conference but about keeping children healthy. I'm at least mildly qualified for that, I guess.

 Fever, diarrhea, and antibiotic resistance, my favorite topics.

Sunday, May 14, 2017

For my nursing friends, at least you weren't getting transfer report from me this morning. Me: "I'm bringing you this patient from Obule Health Center. She is a G2P0 in active labor.She was c-sectioned last pregnancy. I don't know when her labor started as she won't talk. Her water broke about 25 minutes ago. I don't know how dilated she is as she won't let me check. I don't know FHTs as she won't let me near her. She is mad (meaning mentally ill) and HIV positive. This pregnancy is the result of insestual rape." Nurse midwife receiving report: ".............." Me: "Which doctor is on today?" Her: "No doctors currently on duty." Me: ".............."

So, update:  Lets start with the good news. Mother did finally get her c-section.  Both mother and baby survived the experience.  Ummmm, I think that is about where the good news ends. Keep praying.  Mother responded very poorly to anesthesia (general, not spinal). First under anesthetized, then way over. Now, out of her mind. Kicking, hitting, biting. She has pulled out two IVs and her foley. The baby was next to her on the bed for a few minutes and she almost successfully threw it on the floor. Baby is doing slightly better than her mother but also needed serious resuscitation (possibly for the same reason her mother did?!) Tiny little girl. Weighs four pounds. She can't seem to keep her body temp up and power is off so they aren't putting her in an incubator but at least now her sats are holding. We have not successfully gotten Retrovir  (infant antiretroviral prophylaxis) because it is the weekend, but hopefully tomorrow. 
This is baby girl with her grandmother. 

Mother after we had to knock her back out to keep her from hurting herself and us. 

My sediments exactly, kid!

Friday, May 12, 2017

Topping today's playlist.....

Listening to this today. Mercy Me- Even If

I'm stuck at home because my truck is back at the mechanic. So I decided to re-grout the tiles in my kitchen. Though that implies that they were grouted when I moved in. They were not. Just packed with clay. Which is really gross when kneading bread, rolling out pie crust, really anything that touches the cracks between the tiles. So I used a screwdriver to scrape out all the clay and started over. I'm rather pleased with the end result.

Monday, May 8, 2017

Some days are just... rather disagreeable. (I'd like to say just suck but I'm a missionary so I probably shouldn't say that.)

I know it happens all the time and it isn't that big of a deal but it is still a let down when it happens. I had a primigravida mom laboring in the clinic today. She came in late last evening and the midwife was up off and on with her in the night. Around six am her labor stepped up, so by the time I arrived at eight the midwife was ready for a few hours off. I could understand why. The mom was laboring well but needed quite a bit of support. Which is actually a bit unusual for women here, as they tend to labor alone without much intervention. This mom was needier but I don't mind it as it is more of what I'm used to, so I willingly took over. However, there were also 20+ prenatal cases to see. (I totally lost count but finished off a new 500 tablet container of prenatal vitamins early in the morning and at 30 tabs per mother that is at least 17 women that I saw before 10am.)  The  mom was having strong contractions and not handling the pain well but was up moving around and dilated several cm between when I arrived and late morning so I thought we were doing well, except the head was poorly engaged.   We tried lots of different tricks and everything else was fine so it just seemed like we were in for a long labor. Besides, it was taking me forever to get through all the other patients so I was going to be around the clinic for most of the day.  I was checking  FHTs often and initially I would have charted good variability (not that there is any charting here) however by one pm possibly they could have been called variable decelerations but really they were on the way to late decels. Without an actual tracing it was hard to call it but it didn't feel right. And the mother was weary and fully dilated and the head was still high. I was in the midst of discussion with the midwife when we had a snake bite patient come in that kept us all tied up for a while.  Then when I slipped back into the labor room in the midst of a really strong contraction and put the doppler on it barely registered 90bpm, so our decision was made. The good news was in the process of getting her up (leaking amniotic fluid all over the place) and loading her in my truck (that is going to smell nice for a few days) the heart rate came back up.  We made the 20 minute trip into town and I unloaded her directly into L&D. Technically we're supposed to register and crap first but there are a few perks to bringing in more than twenty patients per month. The staff really snapped to and patient was headed to surgery shortly thereafter.

Little side antidote, I usually use the clinic delivery stuff when doing it there but I also carry a delivery kit for home/side-of-the-road stuff. Today I cracked open my own kit because the clinic midwife was sleeping and I couldn't find some of the supplies that I wanted.
I tossed a disposable chux under the patient. (Every american nurse knows what I'm talking about but for you non hospital people it is this thing. We use them for any and every leaking fluid. As a matter of fact, even if you aren't leaking anything, but might be in the future, you get one tucked under you somewhere.) Well, the clinic staff went nuts. They think this is possibly the best medical innovation ever. Now, I've given them a doppler, an autoclave, a BVM, an obstetric calculator, and a variety of other things to make their lives easier. This one takes the cake for them though. They have requested a carton. I had to sadly explain that I only have three left and I am saving them for emergencies.
In other news on this lovely Monday, my dog has been missing for three days and is presumed dead. It seems that no amount of attempted bribery of the neighbor kids is going to bring him back this time. Also, one of the secondary school kids that I sponsor got really good marks this term and I had promised if he got Division 1, I would get him into a better school. He really impressed me with his hard work, so early this morning he was over to get the necessary requirements to transfer. Then he proceed to steal 300,000 shillings when he though I wasn't looking. This like three months wages for many people here. This is the third time he has been caught stealing from me. (How many times have I not caught him?!?) So we are done. Completely. What he stole was less than half what I would have paid in school fees for him next term so I can't figure out what he was thinking. More than anything else it makes me sad because he has such potential. But lets be honest, it also makes me pissed off. Oh, that seems like another thing missionaries shouldn't say.

Thursday, May 4, 2017

Mango season and medical pictures

There are thousands of pounds of mangoes just dropping off the tree and rotting right now, so this week Christina and I showed several people how to preserve them. We peeled, cut and dried several full basins of mangoes.

Also, completely unrelated, but because I'm pulling pictures off of my camera.....
I'm getting much faster at suturing. Now you no longer need to chose between quick or neat. Possibly you can have both if, like this young man, your bull's horn catches the inside of your arm. 

Also, I've put on my first hip spica cast. This is mid way through the process and after my patient received a dose of morphine.  

Also, I have a little guy with clubfoot who is almost finished with his casts.