Christmas stuff

A few pictures of just doing life the days before Christmas.....

 When all of your Christmas decorations fit in a shoe box you use all of the Christmas cards you've received since living in Uganda.

It was really hard work getting good gifts for friends and family but well worth it! Started planning way back in July to get it packed and delivered here! 

I had most of my sponsored kids over this morning to help me get ready for Christmas dinner at church tomorrow. That meant killing several ducks.

Making and frosting 6 dozen cupcakes. 

 And of course opening gifts and receiving new clothes for Christmas.

Prayers please!

I'm headed into the clinic in just a few minutes. I don't usually go in on friday but I've gotten a call that a young woman is in labor and as the midwife is on her own maternity leave I'm the available staff member. But also the district has given us hundreds of Hep B immunizations to dispense. A radio announcement has been made that we will be giving them free of charge TODAY. We are expecting between 600 and 800 people to arrive. And each one of them will need to be screened first before we can immunize. That is a blood draw and test per person. Back on Wednesday I visited another location that was doing it to learn how the process should work. It looked like this

Hundreds of people waiting in lines..... It will be at least 100 degrees today, and our clinic is smaller than this one. Oh yeah, and don't forget that I have a women in labor in the midst of this chaos....How soon until my Christmas vacation starts?!

Update- Survived the day. It was touch and go at times but we all pulled through. I think we even may have had a little fun. Lots of community members pitched in to get more than 600 people registered, tested and injected. We also had a little baby boy born in the midst of the confusion though somehow I didn't manage to get pictures.

Miracle Mary

Our amazing little miracle, Mary, is going home today! Even the doctor admitted to me the other day he never expected her to survive. I'm sure it was the prayer from all over the globe! She is doing really well but is actually not quite ready to go. However, we've pushed up the date of her discharge because of terrible news. Her father committed suicide yesterday and the burial is today. Mary really wanted to go and be there so, hence the early discharge. I never met her father and really know nothing of him except that he was also HIV positive. I don't think anyone had any idea he was so depressed.
Mary was brought to me in Obule but she is actually from Serere, which is something like another 20km further away. I couldn't take them out to there so they had to pack up several weeks worth of stuff and a physically handicapped child and get on public transport. Life is just tough here. Please keep praying for this family!!

Smiling is still tough as all the muscles of her jaw are still very tight but she wanted me to tell you that she is very happy even if she doesn't look like it. 

busy

Some weeks I have time to get a post or two up. Other weeks I'm happy if I have time to shower. These past two weeks have been the latter. Last weekend I was up in Lormoruchbae with my brother, Benj. We had a community Christmas goat roast.

 Also spent several hours hiking between villages bringing meds, birth kits and "gifts" like salt and soap.

 Also told the Christmas story in the evening to anyone who wanted to listen. And treated just a few sick kids. Even though it is dry season there is still malaria in Karamoja.

Just a bunch of "clinical" pictures off of my camera.

Going through roughly 80 birth kits a week means "processing" lots of supplies to pack in them.

You can't purchase sterile gauze in this city so now I make my own regularly. 

When you only have a few otoscope tips left you have to boil and dry, repack and reuse. 

I was reminiscing about disposable trays and ready packs. Like IV start kits, suture trays, delivery kits. Now I make my own and they have to be refilled and repacked regularly. 

Our freshly cleaned  and ready to be refilled "postpartum ward". 

We have a new delivery bed! 

Joyce and Mary updates

Mary, our little patient with tetanus is still hanging in there. Pretty much no change, which is status quo with this disease. We keep her heavily sedated as she still has spasms with even small stimulus like touch or noises. Her swallow still seems poor as she tends to keep secretions in the back of her throat. This symptom is significant because we need to see that she is protecting her airway before we can say she is out of the woods. But, on the up side we haven't seen any indication that the tetanus is progressing so we will just keep offering all the physical support we can and give her body time to fight.

Joyce, the patient with the femur fracture, has gotten worse. She was diagnosed with a "septic joint" this morning and is headed back to surgery, hopefully sooner rather than later. I've been fighting the infection for several days now but couldn't seem to get the help I needed her in Soroti. My hospital of choice, Bethesda, doesn't do any ortho and even though I took her there other day for a second opinion, they couldn't do a CBC and didn't really think she was that sick. However, over the past several days I've been giving IV antibiotics and literally liters of IV fluid daily to keep her pressures up. I'd been trying to reach the surgeon but his phone has been off for days.  Finally, I just showed up at his office and met with the "resident" covering his cases. She took the cast off and pulled the pins and a RIVER of pus came out. Anyway, I'm worried for them and I know they are getting poor care. But at least she is readmitted and hopefully they will do something for her soon. We just trust God to take care of them.

My favorite holiday tradition!

Decorating cookies is hands down my favorite Christmas tradition. The weekend of thanksgiving I had a chance to do it with my family and this past weekend to do it with friends. Pretty sure I've eaten about 200 Christmas cookies already.....

Rachel Graham gets credit for the majority of these beautiful cookies. Except these creepy angels. That was all me.

I've also added this lovely tradition. Pizzas that look like Christmas! Check out the stars on this tree! Christmas looks different here in Uganda but we still do things to make it feel a bit more familiar.

I just want to be a nurse.

Yesterday on FB I posted:

 "Wrote some orders then charted vitals, meds and even I&O's. Felt like a real nurse again! But then tried to tell the doctor that my patient smelled ketoacidotic, received a very blank stare and the feeling promptly went away." 

I really miss being a nurse. I know, I'm still a nurse. But very little of my time right now is actually functioning in that capacity. In the states if I had told a patient's doctor that I was worried about ketoacidosis we would have had a dialogue, I would have possibly received some orders and I would have then done what I was told to do. Here, I first had to explain ketoacidosis, then explain why I thought the patient had it. Then I strongly suggested the things I thought "we" should do. Then I had to assure the doctor I would pay for those things. Finally, I could get around to doing the things that needed to be done.
So, what I actually miss is just following orders?! Seems strange but I guess it is true. I don't want to diagnosis and prescribe. And I don't want to doubt every order that I do get.  But far too many times the meds they write for are a poor choice or they are missing key things that should be considered or addressed. They aren't looking at lab work or considering things like getting an EKG. They are content to wait 24 hours "to see if the condition worsens" to do things like an ultrasound.

I started this post early this morning but needed to stop to get to the hospital. Arrived there to find no doctors on. So I rounded on the patients I brought in and got updates from the night nurses on how things were. Wrote orders for labs, adjusted meds, updated family members and gave Mary her morning tube feeding. So, one of the many things I did this morning was actually a nursing responsibility.

Seriously tempted right now to see if Saint Mary's has any open nursing positions.......

Updates on all these kids

I want to update you on all these kids I've been asking you to pray for lately. First Mary, the little girl with tetanus. She is stable but was very agitated and painful most of today. We've been attempting to feed her but her NG tube is small and giving us serious challenges. However, she is breathing well and hanging in there. Of the two little babies from the previous post, one is more stable now but the other the family had to be told there was nothing more we could do and they should take their baby home (pictured here). That is always a terrible conversation to have. The family decided to take the baby to Soroti Main and I understand their desire to try everything possible but Bethesda's NICU is head and shoulders above anything the government hospital could offer.
Abraham is also still at Soroti Main, waiting to receive his second unit of blood. He was supposed to be there a few hours yesterday, get his two units and come back. Here it is 24 hours later and he is still waiting....  They are still talking seriously of splenectomy for him.  This will possibly be the upside to everything taking so blasted long here. He may avoid surgery because he'll be out of crisis before they get around to it. Lastly Joyce. I'm really tired of "sterile" dressings on her.  A curious pig messed up my field today. How many nurses do you know who complain about that?  Her cast has started to migrate down her leg because she has lost muscle mass which wouldn't be a big deal except that now the top window of the hole that we cut in the plaster rests on the pins. Both pins still move all the time so she has open wounds around them. And in the past few days the pins have really shifted. She is having far too much pain so tomorrow I'll be trying to get some more x-rays and see if we can figure out what is going on.  Thanks for praying and keep it up. Please pray for this nurse too as I'm quite tired this evening....

Lots of sick kids!

Two more prayer requests!!  These little guys need far more resources than we have!  

Also, Abraham, the little boy with G6PD is back in the hospital with a Hbg of 5.2. There is a doctor here pushing for a splenectomy but we REALLY don't want that. Please pray for all these sick kids.