Vacation!

I'm on a much needed, rather spontaneous vacation with two friends and loving it! We are headed out in 2 minutes so this is just going to be pictures. Will write about it eventually....

Sorghum

Another little glimpse of live in Lormoruchbae. Right now the ladies are preparing the sorghum that they harvested for selling.  Sorghum, by the way, is used in the states predominantly as animal fodder. Here it is the best staple food they have. It was all harvested a few months back and they have been using little bits of it slowly each day as they were eating it but they need money so now they are getting some ready to sell. That means getting it out of storage and drying it again. (Mostly this step chases all of the bugs out of it.) 

Then it all has to be threshed. This is back breaking work in the heat of the sun.

First it is pounded with big heavy sticks to break the majority of the seeds from the stems. Then it is pounded again with smaller sticks to make sure no seeds are missed.There were 7 of us pounding and it still took nearly 6 hours.  I was HUNGRY by the time we finished and yet we couldn't even eat this because it is for selling. ( I was also ridiculously sore and exhausted but that is not the point of this post.) Besides the sorghum still has to be ground in order to be palatable/cook-able. And grinding it is also a few hours of work for a normal sized family to have enough to eat. 

Milling sorghum

The longer I stay with these folks the more surprised I am that they can survive at all. It seems the average women here must burn 3,000+ calories in a day (more if she is pregnant) and there just does not seem to be enough calories to go around. I was very happy to go back to my hut and make some mac and cheese. (Thanks so much Mary for sending some!!!) And I felt quite guilty that in 30 minutes I had a hot meal ready to go while most of these ladies were headed out to their field to dig up some cassava which needs digging, then the hike back, then peeling and an hour of boiling before they will have something ready to eat. 

It just doesn't seem fair.

Cassava- their dinner

My dinner

Since the start of the new year I've been able to spend nearly 60% of my time in Karamoja. It has been good for building relationships but it means 30 nights sleeping on the ground, roughly 20 basin baths by the light of the moon (not every day up there gets a shower if I'm running low on water) and about 1,000 km in the truck. Currently I'm staying in Daniel and Rachel's house in Lormoruchbae. I'm pretty disorganized but when staying in a mud hut it seems like one can have lower standards. 

I'm so excited that the season is changing. You can feel it in the air. It is still 100 degrees but there is just a bit  more humidity. People are spending all day getting their fields ready. The rain is coming!! One evening we had a tiny sprinkle that didn't even really make the ground damp but the plants responded.
Sadly, this also means I won't get to spend nearly as much time there because as the roads get impassable I'll spend more time in Soroti.

This was an interesting wound because I'm pretty sure he had maggots in the side of his foot. I only took his picture after I was done cleaning and dressing the wound though so you don't have to see how bad it was. You can kind of tell from the expression on his face though what he thought of the whole thing. (BTW kids here are very tough!) 

Trying to build a house....

I'm in the process of building my own house in Karamoja. And it is a process. The women are helping me a lot but they are also building their own houses so I need to do much of my own work. Here are a bunch of pictures of the process.

The first step is to build a shade house. This is a very temporary structure so you have some where to escape the heat of the sun and somewhere to cook out of the wind. At this point this is all I have. 

Then you make your "permanent" house. After cutting all your poles and gathering your wood you have to prepare the ground and dig holes. 

Then the poles get set. 

Then the cross pieces get tied on. 

Then roof poles need to be attached to each other. 

Then after 10 people lift the whole thing up and set it in place more cross pieces get tied on and it gets attached to the walls. 

These 6 pictures sum up nearly a month's worth of work. There are no nails, no power tools. Practically no tools at all actually. Machetes, axes and hoes. That is it.

We also have to build fences. Hours and hours of building fences....
This is also one other project I helped with. I actually really liked this one because I got to prove I'm not completely incompetent. After spending three days proving that I'm not very good at tying sticks together with other sticks they told me to do the cutting. And I know how to use an ax! They were all actually a little impressed.

It is a granary to store seeds up off the ground so they don't get wet and spoil.  

I’m headed up again today. Please pray for me!

• For increased love for the Karajomjung and to see them as God sees them.
• For conversations to share Truth, hope, joy and peace.
• For wisdom and generosity as I interact and to help them in the best way possible. 

Well,thats not what I wanted to hear!

I feel... disconcerted, like I've screwed up, or missed out. Like a terrible missionary. Here is what happened. We were on a big outreach in Karamoja. Several days in. Tired but overall pleased with how things were going. We were kicked back and relaxing, enjoying the fact that now that the sun was set the day was finally cooling off. The visitors from the states, the CLIDE staff, the translators and the local evangelists, we had all eaten and we were talking and enjoying each other's company. A discussion ensued as to if we were righteous.
I was shocked and saddened to hear several of them concur that we could all safely say we were mostly righteous. Like 75%. One of them said we can't really know exactly what is right, it depends on the situation or one's motivation. One said there were gradients of sin so some sins got you in more trouble than others. They all were sure that we needed to do some serious work to become more righteous to please God. Even as I was hearing this discussion I was praying and trying to figure out how to interject some truth and to help them see how the majority of this was lies from satan! These are the guys that I've been teaching with for YEARS now! How did I not know this is what they believe?  Worse, have they heard nothing I was teaching through them?  Or were major things "lost in translation"?! Does that mean false teachings have come from me through them? Oh Lord, please let that not be the case!
Most of these guys have been with CLIDE far longer than I, so I made the mistake and assumed that their theology was sound. After hearing this I'm now afraid that some may not even be saved!
Please pray for the people I work with when I'm up in Karamoja that they can know the Truth and that they will be set free! Free from worrying that they aren't good enough. Free from fear that they won't make it into heaven. Free from working to earn God's approval everyday. May they know the Truth that Christ didn't just die for us but He lived for us too!!

In order to never make the same mistake again I want to wrap up this post with some scripture in case you found yourself agreeing with my mistaken co-workers.

• Isaiah 64:6 tells us that our righteous acts are as filthy rags to God. 
• Ecclesiastes 7:20 tells us that no one is righteous. 
• We know that we are all sinners and not righteous.No matter how hard we try, we make mistakes and can't fool God. 
• We also know that we can not enter heaven without being righteous. Matthew 5:20. 
• So where does this leave us? Look at Romans 3:21-24. Righteousness is a gift given to those who believe! I picture it like this: When Christ took my sin, he gave me his righteousness! So now, when God looks at me He sees the righteousness of Christ covering me! 
• There is NOTHING I did or can do to earn this righteousness. Romans 10:9 says all we have to do is confess and believe. 

Be set free friends from working to earn anything from God!! 

Where is the line between helping and enabling?

So there is this family that I write about a lot, Betty's family. Betty has 5 siblings by four different men. Her mother, Deborah, has a history of being highly neglectful but we are doing all we can to support the kids. A teammate pays their rent. I pay the school fees for 4 of the kids. We are all regularly giving food and clothes and charcoal and other daily needs. Then nine months ago Deborah got pregnant again. They came to me asking for more help. I gave prenatal vitamins and encouraged prenatal care. But here in Soroti there are plenty of free places to get prenatal screening so I declined doing it myself. Three months ago Betty told me her mother was pregnant with twins. I asked if they had gone for an ultrasound and Deborah said she hadn't. I strongly encouraged it again but refused to take them myself. Just before a trip to Karamoja last month Deborah was feeling like it was nearly time. She asked me for money to pay for transport to the hospital and airtime for their phone and a birth kit (items the hospital requires you bring like gloves, razor blade, etc...). I gave in on all these things even though I feel like this mother should be responsible for something herself.

Well, I got back from Karamoja after a exhausting trip and Betty called to tell me her mother was in labor and could I help? I explained I had helped already and they had everything they needed. Betty called back in an hour to tell me that her mother had gone to the hospital but had not brought her basin and things with her so could I help?  I explained again that I had already helped and if her mother knew she was going to the hospital why had she not brought her things with her?! 30 minutes later Betty is back on the phone with me but by now she has run out of airtime so she keeps flashing me and then hanging up to get me to call her. She tells me that something is wrong and I really need to come help. I explain one more time that they are in the hospital, doctors are there, I'm too tired and please stop calling me. (By now it is 8pm.) 45 minutes later she starts calling me again. And again. And again. Finally I call back. She says that actually they didn't go to the hospital. They just went to a little clinic near their house. It only has one nurse and she doesn't know what to do. Something is wrong. At this point I begin finding scrubs and putting my birth bag in my truck. But I'm angry. Not so much at Betty who is just a really scared kid who has no one else to call for help. But I'm angry at her mother. Why didn't she go to the hospital?  Why is her lack of planning my problem?! 

I arrive at the clinic and got "report" from the "nurse". (I'm not convinced that is what she was.) "She had been in labor since 4pm and nothing is happening. The baby is just too big." That was her report. I asked to see the prenatal notes and discover Deoborah has had NO prenatal care. I asked the nurse about FHTs. She didn't know. I asked about rupture of membranes. She wasn't sure. Are you kidding me?!  It was obvious contractions were strong and frequent and things actually looked pretty normal. Her bladder was full though so I thought maybe we could get her to pee and things would start progressing. I pulled a glove on and did a quick cervix check. She was fully effaced and dilated beyond 7cm but was still high (-1?). She had obviously ruptured already and there was thick green meconium.  Sh*t! This "nurse" was obviously not set up for any resuscitation and had already told Deborah that she needed to go to the main hospital so we packed her up and got her out to my truck.  Thankfully things happened pretty quick once we arrived. We managed to walk (carry) her into their "delivery" room. (Currently had THEE other women pushing and one having a repair all in the same room.) The doctor was actually around so she did her assessment while I put a foley in. The midwife got an IV started and the decision was quickly made to set up for c-section. While the doc went off to prep the OR, Betty and I had the responsibility of finding a gurney and getting her mother on it and over to the theater. (Different, unattached building with dark, uneven sidewalks). I wish I had pictures because there really is no way for you to picture this stuff.
As we navigated the dark walkways between buildings we were approached by the doctor. She told me that they didn't have a nurse who could do neonatal resuscitation so would I "scrub in" and join them in surgery. Gulp! Are you kidding me?! So as I said yes out loud in my head I was thinking when was the last time I reviewed that?!?

Thankfully he didn't need any resuscitation!! 

But things went well and he didn't need any help after suctioning the crap out of his nose and mouth and toweling off.  I can't tell you what his apgar scores were because I didn't take them but he was crying right away and had a great pulse. I'll be spending some time reviewing that in the near future. While I was calming down after seeing that my patient was fine, things were not going well with the mother. They couldn't seem to control her bleeding. She was hypoxic, hypotensive and hypothermic. The doctor looks over at me and tells me to give the baby to her sister and go run and get pitocin and three more bags of fluid. I guess OR didn't have either. As it was 11pm and there were only six of us in the whole of the operating ward  (the doctor, anesthesia, Deborah, Betty and another nurse who was holding pressure on the uterus) I was the only choice to run find supplies.

In the OR recovery room Betty was made responsible for a 5 minute old baby while I went back to the labor ward to find some pitocin and more IV fluids.

I think I woke all of these people sleeping on this sidewalk at least three times going back and forth, bringing the patient through and running for more supplies.

The women's post surgical ward. I wish you could tell in this picture than there are 16 people sleeping out on the veranda/ sidewalk. 

When I finally crashed in bed at 2am I remembered I said I wasn't going to bail this family out again. They they needed to start being responsible for themselves. If Deborah had gone for prenatal checks... if they had gone to the hospital instead of that little clinic.... if she hadn't gotten pregnant in the first place....
I couldn't help but lay there and ponder where is the line between helping and enabling? 

Two little deaths and a little chance at life.

I have just gotten back from Lormoruchbea where it has been a tough couple of days. I had barely arrived and wasn't even fully out of the truck yet when the brought me the first little kid. A little more than a year old but not yet two, he was extremely lethargic, cold (hard to be when it is 95 degrees in the shade) and obviously extremely dehydrated.  I didn't have a translator with me but I think I understood he had been vomiting with diarrhea for a few days then it stopped. His breathing was really fast but then he would stop breathing. I tried repeatedly to get an IV line in but never managed. He died within an hour of my arrival. They all took it in stride with an attitude of "these things happen".  But it just make me so sad because the death of a child isn't something a mother should think is inevitable.   Unfortunately it got worse. The following day I woke to the sounds of yelling outside my house. They had brought me another little one from a village about 30 minutes walk from Lormoruchbae. This one maybe 7 months old. She was also dehydrated to the point of death. It was still two hours to sunrise and I don't drive in the dark when I'm in Karamoja so I prayed and waited with them. But it was too late again. They packed up the little body, the mother tied it on her back and they headed back home as the sun rose.

ORS packet

Over the course of the day the VHT and I went around and assessed other young ones in the village giving out packets of ORS to anyone who had a child under 5 years old with diarrhea. Which was all of them. I couldn't assess if they all actually did or if they quickly figured out they got something free if they said they did. I didn't fight with them. These packets are salt, sugar and potassium and I can get them for .25 so we gave them freely, talking about dehydration. We discussed with them about how bad their water is right now because they haven't had rain in so long so they really need to boil it first. Mothers nodded and said they understood. But I've taught this before. It all feels so hard.

Assessing kids for dehydration

The long, hot walk to get water

Has it seriously been two weeks since my last post? More?! Good grief. It seems like just wishing I was better at keeping you all updated is not enough.
Until I get my act together here are some pictures from last week.

Why do I even bother?!

I'm a bit fed up with it all today.

A few days back I got an urgent call from one of the families that I spend a lot of time with when I'm in Soroti. I stopped what I was doing and headed over to their house and it was explained to me that Joyce ( their 11 year old) was "very, very" sick. Thankfully it was not nearly as bad as they presented. Since that morning she had nausea and vomited several times. As she wasn't feverish nor did she have any other symptoms I just switched her from the porridge they were trying to give her to gator-aid and tried to teach a little about clear liquids, hydration, etc. I suggested they let her rest and encourage her to drink even if she keeps vomiting and I would come back and see how things were in a few hours. When I came back to check on her that evening she was playing with her little brother but said she was still nauseated. I gave pepto, confirmed that she drank all of the liquids I had given her and that she hadn't vomited again since I had been there and reassured them it was most likely a stomach virus. They asked for money for medicine. I ran through my whole spiel again. No fever. Just a virus. Needs fluids and time. Antibiotics would be useless for this and possibly make it worse. She was getting better and really didn't need anything. Thought they got it and headed home.
Several days later I got another call that the little brother had "collapsed" and was also now "very sick". I found a lethargic but fully conscious kid who was vomiting but had no fever and seemed to have exactly the same thing his sister had had a few days before. I explained why I wasn't overly concerned, gave them more gator-aid and prepared to leave. They stopped me and asked for money for treatment. I explained it, rather patiently actually, all over again. Stomach virus. No fever or other symptoms. Needs fluids and rest. No treatment necessary. They told me that actually with the other child they had taken her to a nearby drug shop and purchased some malaria treatment. I asked if they tested for malaria first (because it isn't malaria season and highly unlikely to be malaria). No, they had not tested first. They didn't have enough money. (This was said in an accusing tone. They had asked me for money and I hadn't given.) I asked how many doses she had gotten. Two. Out of the necessary six or eight for a full malaria treatment. But they assured me that she had only had "slight" malaria so they didn't have to purchase the whole course of treatment. She felt back to normal by the next day so the treatment must have worked and obviously the little brother also needs that so I should give them money.
Now, taking a step back. This family has gotten treatment from me MANY times. Several times, when I've tested and gotten a positive for malaria. So treated them.  They also have heard my tirade spiel many times about partial/ under treatment for malaria making it worse.  And how malaria never gets better in one day.  And about how bad it is to treat for malaria without a positive test. And about how malaria has fever, and body aches, and vomiting and headache all together, not usually just one of those symptoms and not just for a few hours.
So, why, after they called me and I came, do they just do what they want anyway?  I know they are ridiculously poor and don't have money to just throw way. And I think I have proven myself trustworthy in the past.
And possibly, if this was one family or an isolated incident I wouldn't even be writing about it. Yet, I have been teaching this same thing about malaria and treatment and the importance of a positive test and the actual symptoms for a while now. Why does NO ONE believe me?!

Low Maintance

I know I need a real post but I'm hot and tired and have been on this stupid computer practically all day so you get these pictures instead of a real post. This is my current favorite pet. His name is Low Maintance or Low for short though his name doesn't actually matter as it isn't like he comes when I call anyway. I've had him more than 6 months and I'm pretty sure my parents doubted I really had a tortoise because we didn't see him the entire time they were here. I don't feed him or water him or clean up after him and he seems pretty happy with our arrangement. 

Compared to my other pets which go out of their way to make my life more difficult. 

I put this picture Dad so you would believe we were in my yard instead of having just taken random pictures from the internet.

Celebrating the new year in Karamoja

I was up in Lormoruchbae to celebrate the new year and these pictures are not going to do the celebration justice. There was dancing and singing and dramas and more dancing. 

Starting the night there were two groups that had a dance contest. Both groups did seven songs then we all decided on the winner. This group of girls won.

 The young men were serious about putting on dramas.  I suspect there was very little rehearsal but there was lots of laughing and it seemed like if you spoke the language they were very entertaining.

Lots of dancing and singing by "audience" members between presentations. 

Some audience members, myself included, chose to just sit and watch. 

Another drama about an old man searching for his wife. (I think.) 

There were even some musical instruments. (PVC pipes and referee whistles)

Other reading

I liked this blog post and not just because I suspect the background picture is Uganda. It is stuff I regularly feel and struggle with. Please read:  God with us



I'm headed out for several nursing calls today. A bad burn (9% full thickness) on a 8 year old boy needs to be redressed, a 5 year old with a deep abscess, and a bunch of other odds and ends including a review of family planning for several ladies who asked me to explain it again.
May I be the hands of Christ today, filled with mercy and compassion. Lord, help me to honor you! 

What my "office" usually looks like at the end of a day like today. Could use an office assistant. Any takers?

Christmas Caroling

Here in Uganda we have to work a little a lot harder to make Christmas traditions that feel like the traditions we are familiar with, but that doesn't stop us from trying. This evening we did some caroling. Honestly it felt pretty strange. We picked four songs and taught them to our Ugandan friends, then wandered the neighborhood. We were all dusty and sweaty by the end. Especially the dads who were carrying their kids. Their shirts were soaked through with sweat. The locals had never seen anything like this. A (mostly white) group of people walking around singing songs they had never heard before. We got plenty of strange looks and a ton of open staring. We walked past and even sang in two different places where people spend most of their time drunk. There are an astounding number of children just left to their own devices who followed us the whole time because they have nothing else to do. I felt awkward and out of place. And hot and a bit annoyed.
But while standing in a grassy field, with chickens and goats and even a cow milling around, surrounded by dirty neighbor kids, and grass thatched houses I couldn't help but really think about the words we were singing...
Long lay the world in sin, and in its error, pining, longing for the return of its King.
The weary world, all around us...desperate for that thrill of hope.
His way is love, and he offers abundant peace. Something this neighborhood really wants.

This isn't just a silly Christmas tradition.  These words that we were singing are huge!

Fall on your knees! Hear the angels from two thousand years ago saying to you now: "I bring you good news of great joy!"  

Lord, even here, don't let me overlook the reasons that I can sing of your Joy to the World. Help us all fall on our knees and your power and glory evermore proclaim! 

O Holy Night! The stars are brightly shining,
It is the night of the dear Savior's birth.
Long lay the world in sin and error pining.
Till He appeared and the Soul felts its worth.
A thrill of hope, the weary world rejoices,
For yonder breaks a new and glorious morn.
Fall on your knees! Oh hear the angel voices!
O night divine, the night when Christ was born.
Truly He taught us to love one another,
His law is love and His gospel is peace.
Chains shall he break, for the slave is our brother.
And in His name all oppression shall cease.
Sweet hymns of joy, in grateful chorus raise we,
With all our hearts we praise His holy name.