I feel the need to share with someone- here is how my morning went:

First a little background- several days ago I saw some patients out in Pinge (an hour from Soroti with practically no medical resources)and one patient just seemed like he had something big going on. His liver was huge and tender and he had multiple vague symptoms but he was only 28 years old. I recommended he come into town and have some blood work done. He wasn’t convinced he needed to do that so I told him to call me if he changed his mind and wanted my help. Well, this morning he came into town and I met him at the hospital.  He looked way worse.  I went into the consultation with him and the doctor agreed that something clearly wasn’t right. Pt was tachy, and short of breath,  had pitting edema in his legs, his spleen edge could be found two finger widths above his iliac crest, also had a huge liver with slight ascites, and nausea. (But no fever or any other symptoms)   We agreed on a bunch of blood tests.  I left to see other patients but came back in an hour just as all his results were coming back. The first doctor wasn’t around but another one grabbed his chart and brought us back into the exam room. She started reading bits of it to me “Well, he has Hep B which explains the large liver….. but white count is critical low….” I got up to read over her shoulder.  I couldn’t help but say out loud “look at his ALT and AST, I’ve never seen numbers so high! And his BUN and creat- I don’t think his kidneys are functioning at all.” Her response? “And look at these platelets  (essentially none), we probably shouldn’t send him home.” Meanwhile, I’m thinking: cardiac, check, kidneys, check, liver, check. Yep, multisystem organ failure.   Are you kidding me?!  Then I pointed out to her his Hbg was 3.5. (Reference:  11-18 is normal.  In the states less than seven gets you a transfusion. He was half that.) The doctor told me that they couldn't transfuse there and he needed "further studies" anyway so we packed up and headed off to my favorite place in Soroti, the regional referral hospital. (Note- not actually my favorite place.) 

And now here it is four hours later and I almost have him admitted. I think I should be happier with that than I actually am. There were more than 200 people in the OPD waiting with their referral letters. A portion of those were children with an adult so possibly I could assume only half were waiting to be seen. But there were two doctors on. And at a minimum of 10 minutes apiece…. We had more than eight hours to wait. So I got assertive. I grabbed a nurse I recognized and begged her to “introduce” me to a doctor. I gave him a 30 second rundown on the patient and he grabbed the lab result I was trying to show him and scribbled me a completely illegible note on the back that I took to be an admission order. Richard was still in the waiting area trying to catch his breath from the walk from my truck. The doctor never even saw him. I feel just a bit bad for jumping in line but at least I only took one minute and who needs an assessment or vitals anyway? So I grabbed a wheelchair and took the patient over to the male medical ward where he joined the line behind five other men waiting to get beds and nursing orders. The doctors were doing rounds so it was going to be awhile. I left him there and went to go collect some of the things he was going to need to spend the night in the hospital like sheets, a jerry can of water, food, etc… as home was more than two hours round trip away. I’ll head back shortly to see if we can’t get some blood in him before sundown. 

Visiting new mothers

In the morning on the way to Nakayot. 

The head TBA in Nakayot and Mark one of the the VHTs. 

Well, I went to check up on the birth attendants in Nakayot this weekend and the road was almost impassable. But I managed to get out to the village. They had nine births in the last seven days so they were happy to see me with new supplies.

Have you ever gotten so excited over boots, basins and a few small blankets?!

Our head TBA in Lormoruchbae

One of the mom they expect to deliver in the next few weeks getting her kit.  It has gloves, soap, a onsie, a few pads and a piece of plastic. That is all she needs to deliver. (Hopefully!)  

Delivered yesterday. These women never cease to impress me. 

The mom said she looked too bad for a picture but she let me hold her baby boy. 

Another  mom with her first born. 

How beautiful! 

Well, after visiting homes, the TBAs had identified two high risk mothers that they wanted to deliver at the hospital. Also, one woman who had delivered a week before but needed IV antibiotics due to puerperal sepsis. The hospital is hours away and all three of these ladies needed to be prepared to spend at least a few days there. So they had to take sorghum with them to sell. They don't have ready cash so seeds had to be carried to the town center. I understand this and I want to encourage independence but that meant 300kg of seeds in the back of my truck.  I really tried to keep the truck on the road but with all the weight in the back the mud was just too bad and we slipped off into the very soft "shoulder", repeatedly, and got stuck, repeatedly. Me and three ladies in no condition to push. (In the above picture we helped the third woman and her newborn into the shade. She was in no condition to even stand, let alone find branches and rocks to get us unstuck.) But we managed. It took me three hours to get from Nakayot to Lorangachora (a trip that should at tops take 45 minutes) but we got there and they sold their sorghum.  They each made about 20,000/= which is about $6.00. That they will use for everything, including their hospital bill for the next several days. Then they will walk for two days with their newborns to get home. But anyway, I'm off topic. Then we drove another hour to get them to the hospital. The septic mom threw up in my truck repeatedly so between the mud outside and the vomit inside I have some cleaning to do. But overall it was a good trip. Thanks for praying!

Well, the rain is here

Amazing the difference two weeks can bring in Karamoja.

March 2016

April 2016

Very same point in the road three weeks apart. I feel like I need to remind myself how much I looked forward to the rain coming. Because I really makes my job harder. But this palace is far more beautiful and MUCH cooler! 

Game park

One of the few (it has been a rough week) perks to living in here is the amazing game drives. Last month I had a chance to go with my family. We saw some amazing animals up-close and personal. 

 The lions were within arm’s reach. This is rare and a fun but slightly nerve racking experience.  We also saw giraffe, hundreds of gazelle, water buffalo, hippos, crocodiles, warthogs.

I wish I had more pictures for you but unfortunately I was one of the drivers so I needed to focus on things like not irritating the bull elephants which are known for charging vehicles. 

So I handed my camera off to the niece and nephew. Which means I have lots of these instead. 

 

But it was a wonderful restful time and we had a lot of fun.

Oh man, I hate it when I’m so far behind. Where to even begin blogging again?!  Here is a quick update. My work permit is still “in process”. This is both good and bad. I’m fully expired and my passport is in immigration. Both things that set my teeth on edge. But good in that “in process” is hopeful that I’ll get the necessary permission eventually.  One interesting thing that came of needing to renew my permit was that I’m no longer a partner to CLIDE. They were not able to give me the paperwork that I needed. This caused a bit of turmoil in my life but the local church that I’m a member of quickly stepped in the gap and I’m now (almost) officially under their NGO registration.  I didn’t see this change coming at all as I assumed I would be able to stay with CLIDE but God must have a different plan. This has changed my weekly schedule quite a bit and I’m finding myself in the Obule clinic a lot more but honestly I love it.

 I’m planning on heading up to Karamoja tomorrow for the weekend. I’ll hopefully have an update about that soon.

Thanks for following along with me and I’ll try harder to keep you all updated!

Six years

April already?  Where is this year going?!  I arrived in Uganda in April 2010. That means this is my seventh April here..... Seven?!

You'd think I'd have this thing figured out by now....

Work permit

Well, it has been three years and my Ugandan work permit is about to expire.  I'm trying not to stress about it and just trust God but I'm starting to get worried. I know everything here takes far longer and is far more convoluted that one could even imagine possible.  I've been mentioning my pending expiration to Dr. Moses since January and even this week he still doesn't have the papers I need.  Most of his stuff should be pretty quick like a copy of CLIDE's certificate of registration (as long as it isn't also expired), but others will take quite a bit of time like the a contract with a job description(which I haven't had for more than a year), and a Memorandum of Understanding with Fuel. I'm heading to Kampala tomorrow because one of the documents that I need in the application is a Certificate of Good conduct which I need to get from Interpol. And that requires a variety of documents.

• Will you pray that all the pieces can be pulled together and I can get things submitted in time?
• Will you also pray that God works out all the little details that are outside my control and I just trust Him to do his thing? 

Like a duck out of water

There are 20 ducks living in Lormoruchbae. I'm not sure how they survive but Simon, one of the guys in the village I live in, has been successfully breeding ducks. I honestly can't believe these ducks. Somehow they can go days without water. 100+ degree, sweltering, dusty days. I couldn't help look at them this trip up as I was sitting in one of the tiny patches of shade and thinking that this isn't actually what God created these little guys for. They need large bodies of clean water for swimming and grass and other green things for eating. Instead they get tiny bits of filthy dirty water once in a rare while and get to just try to scavenge what sparse food they can find. 

I didn't have any water to spare but I gave them the little dirty water I was going to throw out anyway and all twenty of them tried to bathe in it. I looked at their burned web feet (from walking in hot sand) and realized that these ducks were going to live their whole lives without ever swimming. This deficient, dis-satisfactory life is not what they were created for!! I found it very sad. Then I caught myself, it isn't just the animals, the people of this village weren't created to live like this either.
They were not created to live with the hopelessness and despair that surrounds them. Struggling for each meal, feeling trapped in their circumstances.  They were created to live confident in a relationship with their creator that sets them free from the lies of this world.
But I guess this is a bit true of all of us.  I'm reminded once again that this world is not our home. We have a perfect place waiting for us. But that place is not here. We are all like ducks out of water. For now.
Please pray that the k-jung will learn to put their hope in God!

hot and dry in karamoja

I was in Karamoja for the first part of this week and man is it still HOT and DRY up there!!! From about 11am to 4pm I'm useless as I needed a shady spot to just hide from the intense sun. I also didn't go up with enough water, making this trip around even more challenging.

The folks of my village are hungry too. Their stored food from last rainy season is pretty much completely gone and the last little bit they are saving to plant when the rain comes. They are eating once a day and it is really hard to see my friends and neighbors so painfully skinny. I cooked a big meal with the extra food I brought up and fed a bunch of the kids but I know it was pretty much a spit in the pond.

There is always lots of work do to but now people get up before dawn and work until after dark to escape the heat of the day. 

Kambucha

So the popular health drink Kambucha has made it to Soroti. I had it in my checked bags. And now I have two SCOBYs growing in my kitchen. 

I don't love the taste like some people do but I love the idea of growing my own probiotics. There are some crazy claims about this health drink, very few of which I believe. However, in my own, one person clinical trial (on myself) I found that there didn't seem to be the same level of sensitivity to pathogens causing gastrointestinal upset as in the past. This is a nice way of saying I haven't had any diarrhea since coming back to Uganda.
Lets face it, diarrhea is extremely common in the developing world and missionaries (even nurses) are not exempt. But I've been drinking a half a cup a day since about mid November and I'm glad I do. I really believe it has made a difference.

It is nothing more than a SCOBY (symbiotic culture of bacteria and yeast), tea, water and sugar. I let it grow and because it is on average 100 degrees in my kitchen I can bottle this stuff about every 10 days.
I'm beginning to think about how I can offer it to my patients. However, this might be a challenge. I don't think two or three days of the stuff will make a difference. It needs a while to improve your gut flora. But it needs refrigeration after bottling which practically none of my patients have. So I'm not sure yet if I can offer it. However, I'm trying to convince other expats who have fridges that it will improve their lives and that it is worth growing and drinking. So if you live in Uganda and want a mother fungus from me just let me know.....

I can't believe i'm still writing about these stupid bank accounts!

If you follow this blog you know I've been trying to get some simple bank accounts. If you don't follow this blog it isn't actually that important. I recommend skipping this post and checking out some missionaries who post far more interesting things than me.
Like this one: The Very Worst Missionary Ever

Or there is always something good to read over at A Life Overseas.

However, if you have read these already and actually care about this STUPID ongoing mess of me trying to get a bank account read on. (Last written about here.)
Election time was very quiet here in Soroti so starting the 22nd I resumed my frequent trips into the bank. I was told I had accounts now but needed to fill out applications to receive a debit card, check books and online banking.  So I had accounts and I could put money in but still had no way to get money out. This didn't actually seem to me to be "completed accounts" but Robert (Mr. Manager) didn't seem to see it that way.  After filling out more forms, making more copies of my passport and signing more things, I also had to sit down with someone else while they set up online banking for me. I told him I was able to do this on my own but he insisted that him setting it up was the only way for me to get a pin number for the debit card. I was so tired of fighting with these guys that I just let him do it his way. This guy was ridiculous. He was their "IT" guy and he couldn't type and it took him forever to just navigate around.  Some of it was his poor internet but most of it was his lack of computer skills. So as he was setting things up for me he assigned me a user name involving all manner of letters and numbers but nothing resembling my name. He also made a password for me. When it got down to the security questions I almost lost it. Part of it wasn't his fault- the questions were the most preposterous I've ever heard. Like "what is the name of a childhood friend?" Well, if I only had one this question would have been fine. I know this is an issue with the bank.  My problem with the IT guy was that as he was entering my answers he spelled two of my answers wrong. I was watching him closely, thankfully as I would have been very frustrated if not. I had every intention of going straight home, logging in and changing everything he had just done but still it was a waste of time and too frustrating.
Anyway, jumping ahead to this week. I stopped in the bank and got my debit card. I'm still waiting on my checkbook but I feel like I actually have something to work with now.
Here is the most entertaining twist of the whole darn thing.....
Literally the day that I have these accounts opened, I read in the news that Barclay's pulling out of all of Africa. No more Barclays banks in Uganda. http://www.bbc.com/news/business-35695601
That seems like an appropriate ending to the way this whole process has gone for me......

Elections

So here in Soroti things have been pretty quite. Elections were on Thursday and mostly people seem to be waiting for the results to be announced today at 4:00pm. Main shops and banks are still closed and social media is still shut down but things are normal other than that.  I'm going to keep all opinions and most commentary to myself but there has been conflicts and clashes in other cities around the country between the main opposition and the ruling party/ military and police. Besigye has been arrested for the third time this week and it doesn't look like he is going to be released this time. This seems to be the thing that makes people the most angry. Please keep praying for peace. 
Here are a few news stories.
BBC
NPR
Aljazerra

Need an intervention.

I have a problem. And I've heard that the first step to solving any problem is recognizing there is one. So here is my problem. I like acquiring new animals. I counted this morning and I now have around 25 pets. Only two of them are allowed in the house and the vast majority of them (all but the two allowed in the house) will be a meal at one time or another but it seems to me if they have a name they are a pet...
Lets start with the most boring:
Chickens/ Chicks- 7?
Cat-1
Dog-1
Ducks/ Ducklings-8

All of them are growing well and are fun to have around the yard. They are very funny if I leave a basin of water out.

Bunnies-5
Hedgehog-1
Guinepigs- 2

The guinea pigs arrived on Tuesday. I wasn't really quite ready for them as food around my yard is a bit scarce due to the dry season but Izaac and Ellie were asking about them so why not?

I have to confess that it takes me a solid hour twice a day to feed and water (and clean up after) all these animals. And I actually really like doing it.

More family!!

So Christina, Benj and the kids are staying with me through the election. Dad, this picture is mostly for you. Both Izaac and Ellie loved the trucks you made!

They are missing you guys but doing great here!! 

I still just need a stupid bank account....

Back on Feb 6th I wrote about this stupid bank account that I'm trying to open.( Story starts here.) I feel like I need a witness or something about how asinine this whole thing is getting.  When I last left off I had gotten a call after business hours that I needed to bring my passport back (for the third time!!)
2/11 I went in with copies of my passport. He took them and assured me it would be very soon now. I asked "which day should I come back?" and was assured "Monday."
2/15 Monday mid-day I arrive at the bank to get my account numbers. Waited more than an hour because there were many people waiting. At least this time I had the presence of mind to bring my kindle with me. The manager brought me to his desk and said "I'm glad you came. We found you are still missing two things." I almost flew off the handle. First, why didn't you call me and tell me two days ago?! I would have brought them instead of just waiting for you to not actually do anything for two days! Second, what more could you possibly need from me?!" Turns out there was a "critical" typo on the letter from CLIDE. And he also needed a copy of the stamp in my passport that immigration gave me. The immigration documents were not enough. I had waited so long already that patients out in Obulle were waiting on me so I didn't want to spend time getting the copies and I knew Moses wasn't in the office to fix the letter anyway. So I told him I'd be back first thing in the morning. Mr Manager said that would be perfect and he promided he would then begin working on it straight away.
2/16 Went to the CLIDE office first thing to get the letter fixed. Office devos are supposed to start at 8am or 8:15 and be done no later than nine but at 9:45 were still going strong. I know this shouldn't really be frustrating but it really was. Finally finished and waited while Moses printed, signed and stamped a new letter. Turns out that even after all this I would not be getting the accounts today. Seems that back on the 11th, the 16th was turned into a national holiday. I guess I had four days to learn of this so that should have been enough. (Don't believe me that this country would create a national holiday four days before said holiday? Here is the newspaper article that ran AFTER the event. Link.) So even though Robert promised, his word actually meant nothing as the bank was really closed and I would not be getting anything.
2/17 Went back again today and started off telling them I was done, they could cancel my application and I would stop bothering them. That at least jumped me to the front of a line that was six deep. Robert (Mr. Manager and I are on first name basis now) tried to reassure me.  He again promised. I told him I didn't believe him anymore. He said it would only be a few more days. I pointed out that tomorrow is election day (banks will be closed) and Friday is only a half day of work.  He seemed surprised that I knew this.  I also told him I was very tired of hearing only a "few more days". He just couldn't seem to understand why I would be so frustrated which actually makes it more frustrating.

Wheelchair for Emmanuel

So way back in Sept of 2014 I met a man out in Obulle who had two broken hips. (Picture here) Hip replacement doesn't really happen here in Soroti and there was little I could do for him. Well, a few weeks back I was given a wheelchair by the departing E3 team who had a few extra. So I brought it out to him last weekend. Emmanuel lays on that mat on the ground all day long. He is carried out of the house in the morning before his son goes to work in town and after his son gets home in the evening he is carried back inside. His wife, the woman standing behind the chair, can't help him as she is also in her 70's. They were very excited about his this is going to improve his life.

We offered to help him get in the chair before we left but he was ashamed to have visitors help him (as he didn't have pants on) and wanted to wait for his son to get home. I'll go back to check on things in a few days but I'm sure they will be able to figure it out.

Going to the polls.....

So in less than a week Uganda will go to the polls to vote on who they want for their next president. Or at least that is the general idea.
I've started to write about this topic several times because campaigning is in full swing and there has been lots of controversy and much talk on this topic. But I need to be careful because this is such a hot topic issue. So mostly I'd like to ask you to pray for peace.

Museveni

Former prime minister (Mbabazi) and former military officer (Besigye) are the major contenders against incumbent Museveni who has been president since 1986. Last elections things were tense but mostly uneventful. Yet later the Supreme Court of Uganda ruled that the election was marred by intimidation, violence, voter disenfranchisement and other irregularities though the results of the election were upheld.  

Besigye

This year things are already tense. People are nervous, the candidates are aggressive and things have the potential to be disconcerting. But the Uganda people as a whole desire stability and peace so things may be fine.
If you want more information here is a BBC article that was helpful.

Here are some suggested prayer points:

• Thanks and praise for 50+ years of independence for Uganda. 
• Request that God would provide the right leadership for the country. 
• That Christians would lead by example the best biblical response to political problems. 
• Against open conflict and violence that puts innocents at risk.