Visiting Ngora High School

Picnic lunch with lots of food. 

I took Betty to go visit Abella at her boarding school on visitation day today. Abella’s older sisters also wanted to go and cooked a big meal for her. While at school the students get posho (corn meal) and beans twice a day 6 days a week and a small piece of meat on Saturday. That is it. No snacks, nothing else. So visitation day is a chance to fatten your child back up and give them a day with their families. I’m glad that Abella’s sisters took the responsibility of cooking, I just had to drive.

Betty and Abella wanted to send Beckie (who is back in the States right now) an e-mail.  It took them quite a bit to compose it but it was good to see them working together. It was a nice relaxing day for me and I know they also both enjoyed it. Only 6 more weeks and Abella will be back in Soroti with us.  

Immunization day at Obule Heath Center

Back on Monday the nurse asked if I would help with immuization day, and sucker that I am, I did. Whoa! The nice little, mostly quiet, clinic was transformed with screaming babies. Between the two of us I’m pretty sure we immunized nearly 50 babies.  Near the end I paused long enough to take a picture of the few who were left in the “waiting room”, which is also the veranda outside the clinic. 

Here is a picture of Lucy, the nurse who is the only one there when I’m not. Lives there and works 24/7.  She is looking up mixing ratios and drawing up a batch of immunizations. Most of what they receive comes powdered so they stay without refrigeration but then need to be mixed before we can give them. Most of  the kids who come have a card that tells us who is due for what, but a few mothers have kids and not cards, or vice versa  in two cases. (In the mother’s defense- they can’t read and have to remember which child is due and brings all the cards not knowing which card is for which child but when you have 7 or 9 children and bring the three you think need you may miss one or two.) There was also one case that as I write it now isn’t as funny as it was after 20 children and a busy night shift but at the time it was translated for me I almost fell off my chair laughing. A mother sat down with her baby on her lap and handed the nurse the card while I started to record in our log book. Then Lucy started going on pretty rapidly in Ateso and the mother got a bit worked up and handed me the baby and quickly left.  Lucy told me she left a child at home who also needed injections and would come back. So, with the baby on my lap, we called the next family in. In about 20 minutes she came back with the child she forgot- turns out it was the twin of the one I was holding.  Oops. 

Fun day but I’m glad I won’t be doing that again in the near future. 

Evalyn and Eunice

I only had two patients all night. But Eunice needed care on the hour and Evalyn on the half. Both are one month old and each weigh barley 1 pound. They need to be fed hourly via tube, vitals, meds, IV for Evalyn and PO for Eunice. Eunice weighs 1700 grams and technically hasn’t hit her actual birthday yet as she is 4 weeks old but I think she was at least 6 weeks premature so she should still be in the womb. When I came on board with her care two days ago her abdomen was horribly distended so she was changed over to only IV, no tube feedings (she doesn’t have the energy to take formula from a bottle).  Tonight’s shift she doesn’t have IV access anymore and consequently is really dehydrated. But her belly is soft. So we’ve been trying 10 mls of milk every two hours and 10 ml of ORS on the other hour. She seems to be tolerating as long as we go slowly but she still looks really dehydrated. Also she cries every time I put anything in her stomach.  But she isn’t vomiting and her belly is still soft.   

Eunice's initial assessment

In the incubator

Then there is Evalyn. She weighs 1500 grams but is losing weight. She is on 5 ml of formula by tube hourly but has diarrhea several times an hour. So she is getting 15ml/kg/hr of LR. That is one drop every 15 seconds. I’m not sure I’ve ever watched a drip rate that closely before. (No pump or burette for my nurse friends). She doesn’t maintain her own temp and only have one incubator so we use hot water bottles under her blankets but that means we need to take her temp often to make sure she isn’t too warm or that the bottles are getting too cold. And every time we try to change her diaper (which is often) her body temp drops and we have to wrap her back up.

Mdnight meds

Both have to stay under mosquito nets as the bugs are really bad and even the thought of malaria could kill them.  And both are on abx though I don’t understand the rational for the specific meds they are on. I hate giving but I still have to follow their orders. 
So that was my night. Lots of diarrhea, tiny IV checks, NG flushes, hourly vitals and I’m happy to report that they are both still alive and kicking.

This are pictures of a chameleon that lives outside my kitchen door. I worked a 13 hour night shift at Amecet last night. I'm sure I'll have some great material but first I need to recover. For now, all you get are chameleons.

Obule HC II

I was working out in Obule Health Center again yesterday. Word has finally gotten out a bit that I’m there so we were busy. For my nursing friends I wish I could explain what this is like but I’m not even sure how.  My day usually starts getting a brief review of what is going on in “the ward”.  This is just a small cement room that has 4 beds but when full usually sleeps between 8 and 12. As it is malaria season the ward is pretty often at capacity. Women, children, men, everyone sleeps there. If it is a child that is sick the mother sleeps with the child in the bed and usually also at least one sibling who is too young to be left at home alone. If it is a woman who is sick her caretaker, a sister, mother or aunt, sleeps with her or on the floor nearby. If it is a man who is sick his wife sleeps under the bed. If I arrive early enough and people are still sleeping it can take me a bit to sort out who the patients are.  And no one has a chart or anything to help me out. Because the sole nurse lives on the clinic compound she is able to keep track of everything. The problem is now that I’ve volunteered to help her out she often takes the day I’m there off and uses the few free hours to go to town. As she is on the clock 24/7 I really can't blame her. So the patients just tell me what is going on. Who has started treatment, how many doses they have received, when they are due for more fluids, that kind of thing. Anyway, after the ward I head to the next building where there are usually a few patients waiting to see me. Yesterday, there was an I&D of a hand waiting and a little kid with a pretty clear otitis media. But it got more complicated from that point on. The next was a young child, feverish with a mother who was insisting it was malaria. Up to this point I’ve been insisting on a positive malaria test before I’ll agree to treat because EVERYTHING here is called malaria and treated with quinine. For example- you stubbed you toe and fell then two days later your knee still aches? From the fall? Can’t be! Must be malaria! Two doses of quinine later (also two days later) and you feel much better. See? Must have been malaria, the quinine worked. Anyway, back to my young patient. I tested for malaria- negative. Then the mother told me that she’d given two doses of quinine already.  Back on Saturday. If it really was malaria, between now and then he should have received 6 doses and still been under treatment. But what she gave was enough to give a false negative test but not treat the disease. IF the child even had malaria-I wasn’t convinced. But untreated malaria in young kids is a killer. So I had to give something. But with lots of teaching to the mother that partial treatment is really a bad thing.
On top of everything else mondays are also antenatal days so I had several pregnancys waiting. I’ve learned over the past few weeks that women don’t really want to come to receive antenatal care but as I’ve been talking to women I’ve been encouraging them to come. The government of Uganda says they give free mosquito nets, tetanus shots, iron and folic acid supplements and malaria treatment to pregnant women. I’ve yet to see the clinic have those things to give away but I guess because I’ve been talking about it people thought I was going to provide. So women came yesterday. I did have a little iron and folic acid to give but not much and the clinic did have enough tetanus for all but I was told by the lab tec they need to receive 5 injections within the pregnancy. What? These women hardly come once. How are they supposed to come 5 times? And what kind of immunization takes 5 doses within 9 months? And most of these women have been pregnant 3 or more times (most like 8 or 9) so haven’t they received it before? I’ll need to find someone who can bring me up to speed on tetanus immunization in this country.  Mostly I did some teaching and tried to estimate their due dates. They all thought it was pretty funny that I would be trying to figure out when the baby will come. They come whenever they want right?
Anyway, that is enough writing for today. It is a challenge out there but like feeling like a nurse again.  I’m sure I’ll have some more stories next week!

My desk

The pharmacy
I'll try to do a better job next time getting more pictures

In which I try to catch you up on the past two weeks.

Back in Soroti and discovered that I haven't blogged for several weeks! Where did the time go?! I've been in Karamoja again, had planned to spend the week and come back Sunday after worship but discovered Friday afternoon that I was missing the bottom half of a rear shock and possibly had a broken spring. Decided that I shouldn't drive all that far so needed to find parts and a mechanic, not an easy feat and one that proved challenging.... But I'm getting ahead of myself. A week after I expected I'm back and let me start at the beginning. This trip deserves a play by play.
6/6 Headed up to Kangole. Discovered that sections of the road were a bit nasty. Passed several stuck vehicles but managed. Then found a long section of lots of water.  These pictures are not a river, they are the road.

The white mercedes in the middle is stuck, forcing the rest of us to the sides. The water is  over the tires of that pickup that is trying to pass. 

Notice in several of these pictures you can see the culverts piled on the sides of the road waiting to be installed. 

This is the mess that awaits us if we leave the center of the road because someone is blocking the way. 

In two of the areas buses, lorries, cattle trucks, anyone carrying passengers really, force their clients off and make them walk the worst of it to lighten their loads to try to not get stuck. It doesn't always work...

Even had to wait a few minutes to let this poor guy on his bike get unstuck before I passed through. The large pieces of white are chunks of marble that the trucks have had to dump to give themselves more traction and/or to lighten their loads.   

But I finally reached Kangole and had an hour or so before dark to unpack, clean up and settle in.

continued....

It was a pretty low key week after that. Lots of language learning and just enjoying being around Kangole. One morning I went over to the home of my language helper and offered to help her dig her garden. Here is my journal excerpt from the end of the day:

6/9 What a day. Worth firing my computer up for at the end of it. I’m in Kangole and my day had nothing specific scheduled. I headed over to the house of my language helper and brought my hoe because it is the season of cultivating and it seems only fair that if I take an hour of her time I owe her some digging. I found her and her daughters and her granddaughters preparing to go to their field. Which is different than the garden. The garden is near the house, small, and has a variety of things in it. The fields however will be a lot of one thing and who knows how far from the house. Loving the idea of a little manual labor and a physical challenge instead of the mental one of just sitting and learning the past tense form of "fetch water" I told them sure.  45 minutes later we finally reach their field.
I’d like to paint a bit more of a picture for you. 9am. Sun already high in the sky. Maybe 90 degrees already. Me walking along with a 10 pound digging implement on one shoulder. EVERYONE we pass doing a double take of this white foreigner heading out to the fields. But apena. (Means: come and we go) We arrived at the field to find several children already busy working. Turns out they’ve been at it for two hours already. The field needs to be turned over and have the biggest weeds and thorn bushes taken out (the smaller ones get to stay). So, I took my place in the line. (In this picture my spot is the hoe that’s just sitting there.)
And even though these kids had worked two hours already they worked me under the table. As a matter of fact, of the only two I could keep up with one was 6 years old and the other was 68. Even the one with the baby tied on her back worked faster than me. Though when she had to stop to breastfeed I could catch up.

Our  first break time. After three hours of working, when I could have really gone for ice cream, or just a cup of cold water, turns out we get a piping hot mug of pourage made with a K-jung favorite, sour milk. Refreshing! The kids sucked theirs down. I had to work a bit at it. When we finally had the whole field ready for seeds we could start to plant. The kids paired up and one would chop a hole and the other dropped two peanuts in. Then the next pair, chopped a new hole, using the dirt to cover the seeds of the first pair. And so on for all 8 of us. Really very efficient. But don’t slow down or you will be run over by the next pair who is sure to be faster than you. And don’t run out of seeds or while your partner runs back to get more or the next crew will be filling in your seedless holes. And don’t swing weakly so that you have to swing again as you will hit the head of your little partner who has already bent down to seed the hole as clearly his former partner never was tired or weak.

These two were as slow as me and my partner and I when I had the hoe and their combined age was 13. 

This was the pair to beat as we raced. 

Our second break at 12:45 with the sun beating down, we are all sweaty and filthy, and finally they look tired too! But there is no shade to rest in.  Early on as I flipped over sod a little field mouse came out of it. As he ran off the kids started screaming at me. I soon learned that I was supposed to beam him over the head so we could cook him up afterward for a snack with all the other little field mice that we captured. Now I know. I had to turn down their offer of sharing with me when they started to build a fire.  I can’t remember my excuse but I’m sure it was a good one.

This was my cut of the spoils

About midafternoon they were finally calling it a day so we left most of the kids there in the field with their rat nuggets still on the fire and we headed back but by then it was an hour walk. I needed a cold shower and some shade. And some substance to eat that didn’t include sour milk or mice bits.

The ones who opted out of the post snack
headed home.

Unfortunately my day went a bit downhill from there as I got back home and it was pointed out to me that I have a very broken shock and possibly a spring too and I really shouldn’t go back to Soroti until that is fixed. Kangole doesn’t have a mechanic or any place to get parts so Monday I’ll have to head up to Moroto to see what can be done for it.  I guess I'll be staying a bit longer....

continued...

6/11 With the help of Val's driver and a local handyman we found a mechanic AND  the necessary parts in Moroto on Monday and he restored the truck to driving condition. It was really too late in the day to consider heading back to Soroti so I was quite content to sleep again in Kangole. Val (as if you wouldn't know who she is- info here)  was in Kangole also and talking of getting out to Nakayot. This is the peace village I spend most of my time but the road has been impassable since early March. I've wanted to go out but knew I wouldn't make it. So seeing how she was confident I decided to stay a little longer to join her. On wednesday morning we packed bags, food, seeds, medical supplies and as many people as our trucks would carry and headed out. The road was terrible.

Members scoping out the "road" ahead before determining that we couldn't pass the last 20 km without getting stuck. 

Murrm piles have been put down months ago with the intention of spreading but haven't actually been spread. So the center of the road is blocked. Then the rainy season came leaving deep sticky mud on both sides keeping us from using the "shoulders".

Digging and spreading the murrm to give us a place to turn around after we determined there was no way through.  

So as Val was determined, there is another road that she thought could be passable but it goes back out and around the mountain and back down to the village.  I'm happy to write that after 3+ more hours of driving we did finally get there. And we passed through some of the most beautiful landscape in Uganda ( though I may be a bit partial).  At one point the truck stopped suddenly and we picked up a 15 pound turtle from the grass who became lunch the following day.  

A food that comes in its own pan. Already on the cooking rocks to keep him from "running" away.

The end result. Yummy!

So we were extremely happily received in Nakayot and spent a full two days there. There were planting projects and agricultural teaching, seed loans, community meetings and lots of medical care. We stayed two nights in Val's hut with the local critters. We guessed with the termites in the poles of the roof that we could hear eating all night long, the cockroaches in the floor, the spiders in the thach, the weevels in the rice and beans, the rats looking for anything they could gnaw on in addition to all the other uncountable critters and creepy crawlies there we hundreds of thousands of us all living under one roof. Heart warming isn't it? 

Anyway, friday mid day we packed up and set off between the mountians again. We passed Nabwal (the other peace village) and stopped to greet everyone there and also distribute more seeds there then finally headed back to Soroti. The drive was mostly uneventful and my bed felt REALLY nice last night. And speaking of bed I hear it calling me again! So until next time...

Two prayer requests

One evening in Kangole as I was walking back home I found this little guy with a  cool "manyata" built. Here there is a big fence that surrounds family homes with the cows and small family gardens inside. This boy had a good representation built with rocks for cows, sticks for people and his little garden drawn inside the fences. 

I feel bad that my last posts have been pretty much just pictures and that today isn’t going to be too much better. I’ve been in Kangole all week and am pretty tired today. I fell back asleep after my morning run and now I’m having trouble getting motivated for the rest of the day. Maybe it will be a “Sabath” and I’ll spend all day in my running clothes (no skirt?!) We’ll see.
A few prayer requests:
I’ll be working one day a week for a while in a village clinic here in Teso. It will be a great learning experience and I’m looking forward to helping the community but am afraid I’ll have trouble, well, conforming. For example: yesterday there were 11 people in the ward receiving treatment. This means IV drip quinine for malaria. It is malaria season so many of those could have been possible cases. But not all. So on top of the fact that there are much better drugs than quinine available for malaria some of them shouldn’t be receiving it at all, because they aren’t malaria positive.  But both the nurses and the patients (no doctor) believe IV treatment is best. So… once I’m in the position to prescribe there what am I going to do? Will you pray for needed wisdom and tact?  I start this coming Monday.
An answer to prayer is that God provided an excellent language helper in Kangole. I’m looking forward to spending more time with her as she is a sweet older lady.  However, learning Nakaramojung feels a bit like wading in wet cement with swim fins on. As God has not yet blessed me with the gift of tongues I need to buckle down and get studying.  I hope to head back up to Kangole early next week.

Women walk everywhere here. Babies tied on, blanket over the shoulder anything on their heads. Just a reminder how nice we have it. 

Mango Accidents kill one, injure seven in Soroti.

I just have to share this Ugandan newspaper article.  First because it has a picture of the inside of Soroti Hospital and second because it so succinctly summarizes what i'm usually griping about in regards to medicine here. Besides it is a great piece of well written news. (Fair bit of sarcasm in there in case you didn't get it.)

Pretty sure that pancreatic rupture was actually a splenic rupture. As much as I would like to write that it was probably the writer that confused it I would not be surprised at all to learn it was the doctor that confused them which would explained why the patient died so quickly. I also find it interesting that the entire first two paragraphs are about this poor kid's "life threatening" urethral injury. And that closing paragraph is like icing on the cake. If you parents would pack your kids a lunch they would stop falling out of trees! O.K.- I'm done. I'm sure I have better things to do.

Just more pictures

Made it back to Soroti without trouble thought it was a LOOONG day of driving on some really rough "roads". Still don't have an pictures of the road, being the driver and all I had a few other responsibilities besides taking pictures. But here are a few others:

Joseph is blind but pretty inspiring how well he does here. 

Naakale outside the clinic

These boys are swimming in the waterhole swamp but they've dug it out a bit so they are in about up to their hips. 

Just a few things

Today was a nice restful day (I'm still in Nakaale) so I really have no excuse for not having a legitimate post except that I just really just don't feel like it. So you get a few pictures and some hope that the next one will be more entertaining.
A snake was found chilling in the trees on the compound this morning and after killing him it was determined that he was most likely poisonous. Glad they waited until he was dead to determine this.

You'll notice his head has been practically completely smashed off. He was stoned to death with thrown rocks then beaten to death again from slightly closer with sticks. You can't be too sure with these things. 

Spiders here seem to be bigger than the average but I think it is because they have more mosquitoes  to eat than anywhere else in the world. 

It really is a coke but it needs a translator.

Direct quote: "Just kill them all. Kill them dead."

Here is a bible story the Karamojung in Namalu are wrestling with this week and their real life application:  They read about David, in the time of his life where he was hiding from Saul. He was being forced to hide and live in caves far from home even though he had done nothing wrong. He was being persecuted and harassed but he was guiltless. As a matter of fact he really deserved better. Then, for the second time, he had an opportunity to kill his enemy, Saul (story can be found in 1 Samuel 26). He had sneaked into Saul’s camp at night and had found him soundly asleep. David’s friends where there with him and all were encouraging him to just kill Saul and be done with it. Twice, God had put David in a position to kill Saul. But he didn’t. He knew that isn’t what God wanted from him. So back to the K-jung. They seem to be continually at war with their enemies. They were challenged with the question “If you come up to a camp of your enemies who were harassing you and had just the night before attacked your home and you found them sleeping, what would you do? They all agreed they would kill them without hesitation. But they are being challenged to think differently and to go against their culture and consider not killing their enemies. David knew that God would be the one to justify him and balance the scale, so to speak. Can you pray with me that the K-jung will also learn how God is our defense and will right all wrongs? Pray that they are able to let go of the belief that they have to be justified and they will be able to forgive and not always be seeking revenge? They think this is a very strange thing, this forgiveness thing, and especially coming from the “white foreigner” it can be easily rejected. But may they know it is biblical and godly. 

"Roughing it" again

Planting!

I’m in Karamoja this week, but in an area further east (nearer to Kenya) than usual and actually it isn't rough at all.  Here I can drink the water from the tap, I have lunch provided every day, a nice shower, bed that isn't on the ground.  I really feel like I'm on vacation.  The roads were more challenging than anything I've encountered yet but we happily arrived without getting stuck and I plan to be here for a bit, hanging out with Leah and the OPC missionaries, learning language, catching up on stuff and just enjoying a quick break from Soroti. I wish I had taken pictures of the road but I was more than a little bit focused on driving- maybe on  my way back down country I’ll get some. Here are just a few others:

With all this rain come the season of planting! Everyone is digging.

Walking from Leah's house to the clinic. 

Mud, mud, everywhere.

Near Soroti the swamp waters are rising! And you can see that storm blowing in. More rain is coming!

Is your morning commute anything like this?

Schools in Karamoja

*wrote this post a few weeks back but guess I never got around to attaching pictures and publishing. 

One of the community development ministries CLIDE has is student sponsorship of k-jung students in Napak district. They have identified children with potential and gotten them in school so they can be instrumental in the future of Karamoja. They are high needs children, who are invited to retreats, encouraged academically, and given opportunities they wouldn’t otherwise have. To do this CLIDE also has to encourage schools in the district because most of these schools are struggling too. They plant a Bible Club in each school and offer free training for teachers who are interested. So the “Timothy Students” as the sponsored ones are called, have a club in their school and any student is welcome. We were visting the schools and I know the education system is struggling all over [some sort of boarding available as they are so far apart that it is unreasonable to expect children to walk, even children who can do 6 or more kilometers in a day. But I learned that most of the time this means that the desks are pushed aside in the evenings and the students spread their blankets out on the cement floor of their classrooms. There are literally hundreds of students per teacher and as Ann put it “a lack of scholastic materials”, though I would have said a complete absence of books, papers, pens, or anything. Well, not everything. They do have chalk. And chalk boards. A student will copy the board for hours a day, essentially writing his own text to study in the evening. And teachers…. That is a major issue too. Most trained teachers refuse to work in Karamoja. So the ones they have are as bad as they get. The first school we stopped at the Headmaster was present but fall-over-drunk. There were 700 students and 3 teachers plus him, but he was passed out by the time we left so I’m not sure I can count him. At one school there were 10 teachers so I was pretty impressed until I learned that there were 1,200 students. Any teachers out there want 120 students in their class? 

A little crowded. 

So this secondary school teacher meets her class outside so there is room for everyone. 

And as I mentioned most kids board. 3 of the 10 schools we stopped at offer porridge once a day. That’s all. World Food Program (WFP) provides enough protein cereal to make one hot meal for kids in Karamoja. And that is all the food there is right now. And for the physical structure? For some schools there are no words. I’ve been out here in Karamoja for two years now and I’m still struck speechless as I learn more. 

There are kids in this classroom but it is too dark in there to see them.

A class also in this one. 

Thankfully, no kids in the one with the wall falling down. 

Dependency

Our team here has been talking and praying much about this issue. We know that it seems to take no time at all to change from a relationship that involves some simple generosity on our part to avaricious dependency on their part. It humbles me to share this example but it was part of my education and I feel I need to. When I first heard of the predicament of the twins (several posts 1, 2, and 3) I rushed right in and provided formula, thinking that it was the best solution. I’ve since learned that it was the quickest and easiest solution but probably not the best one. The right thing to do when confronted with a need is to try to see to the root of the problem and address that for lasting, biblical change. In this instance I could have better looked at the issue of why this family didn’t purchase cow’s milk for their babies. However, it is easier, and makes me feel good, when they NEED me to be the one to just give them milk. But have I really helped the problem?  Instead I’ve come to believe that I’ve actually made it worse. They are now dependent on me.  They feel they needed me to swoop in and “save” them.  I reinforced that they couldn’t help themselves. The father of the twins is an alcoholic, which is one of their root problems, but he drinks to dull the hopeless/helpless feelings. Which I’ve just made worse. It seems to also wreck their faith in God because now they look to me to provide instead of God. And lastly it destroys their relationship with me because, initially they are thankful. But over time they expect more of me. I can’t provide all that they think I should. And I’m human, I occasionally fail. They become mad at me that I didn’t provide. All over a few cans of formula.

So how do we build relationships, make a difference, share the gospel, all without creating dependency? We have to deal with the root problems.  Which, let me tell you, is a lot harder than just giving things away. You have to really confront the much bigger issues. It is a lot dirtier, takes a lot more time and yet it is what will actually bring change. In the case of the twins, they are now old enough that they don’t need milk. Yet, their father is still an alcoholic, their mother still doesn’t have enough to make ends meet, their church is still just a place they go on Sunday and isn’t officering any hope.

And of course it isn’t just formula. It seems to be everything. Giving free medicine and medical care? Not actually addressing the bigger problems. Giving street kids food when they come begging? Not meeting the deeper needs. School fees? Why can’t their parents pay? What is the real problem?

So will you pray for us? As a team that we will continue to learn together and challenge each other to be faithful to what God has called us to do. That we can remain generous with all that we have been blessed with but not in ways that cause more harm. With the people we work with who really don’t understand why we won’t just give clothes, food, school fees, etc… With supporters who want to make a difference and donate “stuff” and have a hard time understanding the new things we are learning. We all need wisdom and guidance!