Chicken

My friend Rachel got the Ugandan version of a rotisserie chicken- cooked whole over a grill in Arapi.  Doesn't that look appetizing?! Nice and fat, plenty of neck!! Even still has some extra bits inside for added flavor.

On a completely related note I have so many meals that I'm looking forward to having while I'm back in the states! Very few of which will contain rice, beans or cabbage.....  

Furlough

It is time to get serious about my next home assignment. Tickets have been purchased and I arrive back in GR on September 15th!! I can't wait. It will have been 2 years and 2 months and I know in my head that it isn't actually that long but it feels like it has been a long time.
I'm looking forward to catching up with all of you and spending time together!! I'm scheduling now so let me know if we can do something together. (Go for a walk, grab a cup of coffee, I will even spend an hour cleaning your pantry with you if that is what you need to do.)

Elisabeth

Elisabeth is still hanging in there (wrote last about her here) but she is having a lot of pain, getting quite a bit weaker and is struggling more. Life is hard here no matter who you are but life is really hard when you are 90 years old, have no living family, and advanced cancer. Please be praying for Elisabeth.  She told us she is often lonely and hungry and always in pain.
I've been to visit her twice this week. She reports a bit of relief from the pain at night with the meds which is good. We also brought her a radio to fill her empty hours. Brought food and fire wood too, to try to make a little less work for her but she still needs her water to come from the borehole that is a ways away from her house and she still has to do her own cooking.
A few interesting things we learned while sitting with Elisabeth: She really wanted to be in school but her father took her out to care for the family cows. It was a catholic school because when she was school age Uganda was still a British Commonwealth so all the schools were run by the English Church. She thinks that she remembers that her first born child was about 10 years old when Idi Amin was in power (He is the crazy dictator of the 1970's who is known for insane human rights abuses and the death of upwards of 500,000 people.) One of her children died of illness but the rest were killed in the insurgency of the LRA in the 1980's. I'm in awe of the things she lived through and survived to tell us about. I can not even fathom....
These pictures don't show it well but she is a really joyful lady, laughing and smiling and can't stop telling us how much she appreciates all we are doing for her.

Not getting stuck anymore!

Last month I took the plunge and sprung for mud tires to replace the all terrain tires I used to have. This is blog worthy because the past two trips to Karamoja have been like going in a completely different vehicle. I love it! This picture is funny though because the mud was caked on all the way up to the roof but instead I took the picture after I washed it.

Spending some time contemplating this blog..... my posts are headed downhill fast aren't they? I'll try harder tomorrow.

My headlights are on?

I'm back from Karamoja so have a few posts milling around but they aren't ready yet so I have a humorous anecdote for you in the meantime.
Monday morning I left the village around 6:30. It was really foggy so I had the headlights on. I left Lormoruchbae with 13 people and all their luggage and made my first stop in Lorangachora to unload some of them around 7am. Someone came up to me while unloading and pointed out to me my headlights were on. Here, everyone is concerned with conserving energy because they have so little of it and they understand how miserable it can be when it runs out. And so few people drive they don't understand that headlights are actually not like flashlights and that I don't actually have to worry about running out of battery as long as the truck is running. The belief that your headlights will drain you battery is so prevalent that some drivers won't even turn their headlights on until it is fully dark so you need to be more cautious around dawn and dusk. Anyway, this guy told me my headlights were on. I thanked him and forgot about it. I headed to Matany to drop off some people there. Between Lorangochora and Matany I hit a chicken. I tried to swerve but the fog was still very heavy and the chicken was stupid and I saw a puff of feathers in my rear-view mirror. I wish this wasn't a common problem on the highways of Uganda but it is and I was just happy it wasn't a goat or a cow. Anyway, got to Matany and while unloading was told again that my headlights were on. It was only 8:30 am and the fog was still heavy so I just nodded and told him I knew. I made my last stop in Kangole around 9am and dropped the last few people in my vehicle off in the town center and was actually told one more time that my headlights were on. I just turned them off to get people to leave me alone. I drove over to the CLIDE office and while there I discovered that the chicken I had hit was still embedded in the grill of my truck. Only here will several people point out to you that your headlights are on and fail to mention that you have a dead animal right between them.

Chickens

Seeing as how I've started something with crummy pet posts here is another one. I keep chickens for the fresh eggs, occasional meat and mostly to give away because chickens are the best Christmas present here. Right now I've got three mothers with seven chicks at various ages. It has become rather time consuming getting everyone fed, keeping the mothers from killing each other (they can't tell their chicks apart) and convincing the cat he needs to go hunt something else.

The youngest three. 

A slow hatcher. 

Team work.

Hoping a chicken nugget will escape. 

Cat

Rats

I was flipping through my camera looking for something else to write about and discovered I have tons of pictures of my cat killing and eating things. I tolerate it because he also kills snakes though I don't have any pictures of this unfortunately. Usually because I'm too busy making sure the snake is dead, I guess. Cat also has gotten into the habit of bringing me some of what he has killed. He likes hunting at night. That means he regularly brings stuff into my bedroom. Into the bed if I haven't tucked the mosquito net in well enough. I dreamed a few weeks back that I was trapped in a latrine and woke up to discover my bed stank so bad because the cat had a huge latrine rat in bed. Nothing like needing to change your sheets and shower at 3am.

Birds are also fair game. 

Lizzards are also common. As a bonus they get thrown up the most too. 

 

This was a giant rat. 

He always eats the head off first. I wonder why. 

I just realized I need a hobby besides taking pictures of my cat with dead things. And writing about it. Worst blog post ever. But this is life here.....

The wonderful placenta

Our baby and model placenta

So who wouldn't want to spend two hours talking about placentas?! This was the topic of the last TBA training. We talked about a huge range of things, mostly about what can go wrong with it. And an hour before our training started (or the reason the training started three hours late depending on how you look at it), together we all delivered twins so we had two placentas to look at and discuss. (No pictures of that, don't worry.)

Does this woman look like she delivered these two babies six hours before?!

Demonstrating to each other that they know how to administer pitocin.

 Just for fun you can try to picture me, a laboring woman, her mother, mother-in-law, sister and at least six (possibly more I forgot to count them) TBAs, all squeezed in a dark, smokey, dirty, mud hut. My translator was outside so I would call out, through the wall (no windows) in English, and she would yell the translation back in. The first baby had already arrived and things were going fine so mostly I was just trying to point out things we would discuss later in the training.

Less than 2 kg

 At the end of the training the new mom, both babies and grandma all got a free trip to Irriri Health center. Mostly for immunizations but the TBAs thought there is a WFP (World Food Program) initiative going on right now that gives free food to mothers of babies less than 2 kg. So because she has two tiny ones she would qualify possibly for posho (cornmeal),cooking oil and salt.

Grandma!

Update on Maria and Sarah

I went out to visit Mutia Maria last week. She is the little girl who has TB of the spine. (June 3).  Truthfully, she looks a bit rough. She has pressure sores again already and has lost weight. I'm a bit bummed but knew it was going to be tough for her. Unfortunately, her lung sounds are also worse and it seems like the haven't been giving her TB meds correctly. This is the day they should have run out and we were going to the clinic together to get them refilled but she still has two weeks worth left. Also, maybe the thing that discouraged me most, is that I discovered her whole family is still alive. I had been told she was a total orphan, her mother and siblings had also died of TB, she was a a very vulnerable case. Well, the above picture is her immediate family. They just got tired of her being so much work and had been told that her TB could spread to them so they left her to die. I am glad my TBAs didn't give up on her but I wish they had felt like they could tell me the truth. Maybe it was a shame thing. Not coming from a shame/honor culture I often don't understand why they do what they do. Anyway, will follow up again in two weeks.

Several years old but you get the idea

Ajiko Sarah (Last post here) is doing much better than I thought she would. She has a lot of pelvic pain which we expected based on how her x-rays look. But she is putting on weight well, feels the baby move often and as of this week is 25 weeks along. We are planning doing another ultrasound in one month. Her C-section is still planned for October.

Kind of like grocery shopping when you are hungry....

Kind of like grocery shopping when you are hungry, you know you will probably shouldn't do it but sometimes you have no choice. I don't like posting when I'm discouraged but obviously waiting until I'm optimistic and in a good mood is not really working for me as I haven't posted in far too long again. I've been sick off and on this whole month and the more I ponder it the more I think it has a significant spiritual component. Which, if anything, makes it less easy to cope with.

Congratulations Chip and Susan!

My brother Chip and sister-in-law Susan had their first child this weekend and I'm so happy for them but I want to be with them so badly it hurts so I'm homesick and that compounds my melancholy attitude.
On top of all that I'm hurt and frustrated with International Teams. Next week is my final week with them. I needed to resign. I loved their values and was very excited when I found them as an organization back in 2009. I value loyalty and hate that I felt forced to leave.
Consequently, teammates are now former teammates and several are not around Soroti at this time. It leaves quite a void in my life.
I enjoy the work I'm doing in Karamoja but some trips up are really hard and I'm coming to hate doing it alone. (Like this last one, two patients who were brought to me died. A few month old baby girl who was badly burned after she crawled into a fire died of infection in her wounds and a seven year old little boy who had cerebral malaria or meningitis or something of that nature passed away while I was trying to transport him to the hospital).
Well, so that's it I guess. I'll see if I can drum up a better post tomorrow. But I'm freezing so took my temp and I'm back up to 99.9 so I get to find some tylenol and crawl back into bed.

Leaving International Teams

I hope this isn't new information to people but I realize I'm not great with communicating so here is an update:

Dear Friends and Family, 

I need a few seconds of your attention today to share with you some changes and ask for your help. Due to some events here in Uganda it is necessary for me to transition out of International Teams. I hate the idea of leaving the organization but they have announced they are suspending all ministry work in Uganda. I know that God has not changed my call to Uganda and He has provided a new organization to work with. 

Fuel Uganda is a little mission organization that has been working in several locations in Uganda for several years now. Christ centered community transformation is their purpose, which lines up perfectly with what I've been doing.  My day to day activities will not change at all. I'll still be in Karamoja two or more weeks a month and based in Soroti the rest. Click below to see Fuel Uganda's web site. 

				Fuel Uganda - Community Transformation Fuel Uganda is a non-profit focused on Christ centered community transformation in Uganda, Africa
				View on fueluganda.com	Preview by Yahoo

Here is where I need your help:

I still need your support!  My funding still comes 100% from your donations. Your future gifts to International Teams won't come to me so I need to ask you to send them to Fuel Uganda. 

- There are the same three ways to give and all gifts are still tax deductible:

• Bill pay (free, monthly or one time, automatic giving via your bank's online access.)
• Credit card (Monthly automatic or one time online giving. There is a 5-6% charge to Fuel when you use this option. So if you are giving $100. $95 will make it to the organization.) Click here to give online. It says Give in the upper right corner. Then click Donate.
• Check- Make payable to Fuel Uganda and put Jennifer on the memo line. Mail to:  Fuel Uganda 6328 Country Donegal Ct. Charlotte, NC 28227

If you have any questions please don't hesitate to send me an e-mail. Also, I will be stateside for furlough from September 16th to December 27th and would love to tell you more about it. 

Thanks so much for your faithful partnership with me for the past 5 years, seeing lives and communities around Soroti and in Karamoja transformed by the power of God. I hope you will continue that partnership as we follow God's lead. 

  

Jennifer Kragt

Like a whole new kid!!

Back in April the I brought Maria into the hospital with spinal TB, osteomyelitis, pressure sores and malnutrition. (Her story here.) She has completed her final surgery, is well healed and is ready to go home. I've ordered her a pint sized wheelchair which should arrive on Monday. Now, the challenge is where is she going to go.... 

 She had been abandoned in Nakayot but her "family" (cousins and aunts of her father's family) are from another place. But I'm having a hard time tracking this new place down and finding them. My plan is to go to the hospital on Monday with the birth attendant who first brought her to my attention and see what she thinks. Please pray for wisdom and the ability to do what is best for this little girl. I can't stand the thought that she would be neglected nearly to death, or worse, again. On top of that she has a few months of TB drugs to take yet and I would really like her to complete the treatment and am afraid if she goes back to the deep village they will not follow up.
I'm thinking seriously about bringing her to Soroti to attend the handicapped school. But I'm afraid that her family would perceive that as me taking responsibility for her and that they no longer have any need to take care of her at all. Which they clearly do already, as they were willing to let her die. So, do I just consider her needs?  I think she would thrive in a place where they will help her live with her disabilities and show her she has value as she grows up.
But she is young...
The first term that she would be eligible for is in January.....

Tropical Ulcers (Mostly a completely medical post)

Tropical ulcers. Pretty much a small epidemic in the wet seasons here. Stage One- a pustule, or neglected cut. It seems that any tiny wound like a blister or deep scratch which flies are immediately attracted to will become an ulcer. Stage Two- progression of the pustule to form an acutely painful ulcer with a raised, thickened, and slightly undermined edge. This ulcer grows rapidly for several weeks. A bloody discharge covers the grey slough on its floor, the skin around it is dark and swollen, and muscle, bone, and tendon occasionally lie exposed in its base. Yuck! After about a month or two, the pain, swelling, and discharge improve, and it either heals, leaving a thick scar or it goes on to the next stage. Stage Three- it becomes chronic, and resembles any other long-standing indolent ulcer which over time can cause permanent physical problems. 

Most of the kids in Lormoruchbae (and I would be so bold as to say most of Karamoja) have at least one of these and, like the photo above, some have four or more. I really believe it has to do with the flies. Poor hygiene contributes to the problem but I've had two of these wounds and I use antibacterial soap. However, I don't always get little cuts or blisters covered right away and within minutes the flies on it are enough to drive one insane. I've learned these ulcers are disproportionately painful for their size and I now have a lot more sympathy for my patients. I've also learned (through trial and error on myself mostly) that wet-to-dry dressings are the most effective. (And before any of my nursing friends start to leave me a heated note in the comments section I would like to say I am actually aware that improving practices are telling us that there are much better alternatives to the old school wet-to-dry dressing but please keep in mind that I live in a place where most people still consider penicillin injections to be revolutionary and I don't have access to better options.)  But these dressings need to be changed at least twice a day. When I started doing just a few bad ones last time I was in Lormoruchbae I did 29 wounds before I ran out of supplies. And that was just one morning! 

So, I went out and bought gauze and tape by the kilo. (Literally. You can't get 2x2s or 4x4s here. You get a 1, 2 or 5kg roll of gauze and cut it how you need it.) I packed sterile saline squirts, antibacterial soap, and everything a person needs for a week of dressing changes in a bag. I haven't gone back up north again yet but I plan to run all of this by the VHTs and see what can be done about this little epidemic. It may be a complete flop but it might work.....

Now I spend my free time making 2x2s for wet-to-dry dressings for legs. 

Mud

How is it we are nearly finished with rainy season and I haven't complained about the mud yet?! I guess I'm getting used to it.

Can't believe I got stuck in this tiny mud patch between Nakayot and Lormoruchbae but my tires are pretty worn so they tend to slip down into the ruts and just spin.  And the ground on either side of the road is just too soft as evidenced by the last time I tried to pass through here.  

But this kid helped me toss some sorghum stalks under the tires and that little bit of traction is all it took to get out. I love it when there is no pushing required.

Got out and waded through this one to look for something for the tires to grip.  My translator was being his normal helpful self by playing with my camera while waiting for me. 

If this is all I'm stuck this season I'm quite happy with it. 

Happy Mother's Day!

I know! I'm like a week months late but computer time has been limited. I actually spent mother's day packing birth kits for the midwives in Nakayot.

A huge thanks to all of you (specifically Dar VanOveren) who gathered supplies for me, bought baby blankets, or knit hats and sweaters. The plan was that each pregnant woman in Nakayot would receive one of these to use at birth.  Unfortunately, they deliverer far more babies in a week than I can supply kits for but I know that each kit has extra gloves, the midwives save the antibacterial soap and boil the razor blades so each kit serves several deliveries. 

Traditional birth attendants training

I don't have any good pictures for this post because the TBAs (traditional birth attendants) seem to hate it when I bring out the camera so you'll just have to tolerate these internet ones.
This post is about the most recent training. The TBAs have no problem telling me they think I'm FoS sometimes and this week was no exception. But it is good because at least I know where I'm at with them. The topic was measuring fundal height to estimate fetal age, or "counting the belly to know when the woman will produce" which is roughly how it was translated. The very first thing I needed to establish was that all pregnancies are nine months long. Nope. I clearly have no idea what I'm talking about. 30 minutes and two personal accounts of pregnancies of 11 and 13 months later, I finally just moved on.
We discussed how at 4 months the top of the uterus is two finger widths below the belly button and how each month adds two fingers. I had wandered the village before we began and asked 3 pregnant women to join us. They practiced on these ladies and got it with no difficulty. Then I took it one step further and explained that because we know they will be pregnant for 9 months, when they measure 8 finger widths above the belly button the baby is about to come. They were still not convinced. I suggested they watch the women we measured and see if I was close to right. Next training we will discuss.

But I took it one step further and got out tape measures and told them they could get even more specific. That women gain 1 cm per week and that the numbers correlate so if a women measures 28 cm she is 28 weeks (+/- 2 weeks). Clearly I'd lost them and suddenly it hit me why. "Who knows how many weeks are in 9 months?" Blank stares. "How many weeks are in a month?" Some discussion in Kjung. 2 to 5 depending. Ummm. I tried explaining there are consistently 4 weeks in a month. They didn't completely buy it but they let me continue. I tried explaining that pregnancies are 38 or 39 weeks long so that a woman who is putting on weight normally can be expected to deliver when she is about this size. The whole purpose of this training was to help them see that if they are measuring women over the course of the pregnancy and they are not growing as they should they need to refer them to the clinics. I'm not sure they completely got my points but the discussions were fun....

Ajiko Sarah

This is a new post about Sara, who is a person I've been paying for trade school training for years because she has a pretty serious physical handicap. (Previous posts about Sarah here and here.) I've actually started this post repeatedly and really don't even know exactly what to write. Sarah has gotten pregnant. I'm trying not to be judgmental or angry..... Yet I find myself listing off in my head all of the reasons this was terrible. 

1.) This could very possibly kill her. If there was a category for higher than a high risk pregnancy she would be in it. She breaks bones regularly so the likelihood that this pregnancy will break her pelvis or back is high. I'm not sure how her bones will tolerate the 30 pounds she will need to gain. 

2.) The baby could possibly have the same terrible disease she does. That is, if the baby even survives until birth. 

3.) She lives 10km from the clinic where she has to go to get prenatal care. She certainly can't get herself there. 

3.) Her family can't feed all the mouths it currently has. Two different NGO's give food, medical supplies or pay school fees for her family. How are they going to care for one more?!

4.) There is no father. Well, there is a father. This wasn't an immaculate conception or anything.  But Sarah had relations with no intention of getting married. He is a 16 year old boy (4 years younger than her) who has not yet completed school.   

5.) The training program she is in is run by catholic nuns so because she isn't married she has been kicked out of the program. They don't keep this rule a secret. Everyone knows it. She won't be allowed to complete and get her certificate. 

But she wanted to get pregnant. So she did. Now she expects me to help her. 

She is 5 months along. So far no complications. I check on her every two weeks and once a month I go out and pick her up and take her to the antenatal clinic. This month I also got her appointments with a neonatalogist and the doctor who will preform the c-section. We had a meeting and decided on the absolute earliest date they could possibly take the baby. 

I really struggled this week with frustration with her as we rode back and forth from appointments and spent hours sitting in waiting rooms. As I was dropping her back off at home I realized that even though we saw three different doctors over the course of the day no one had done FHTs or measured fundal height. (This actually isn't all that surprising and could be the topic of a whole different post.) Because I keep my own chart on her to keep things straight in my head, in the dark little hut she sleeps in we did one last exam for the day. When I said, "that is the baby's heartbeat, strong", she lit up. And I realized that I've been so frustrated and discouraged that I had never really thought of her as a young mother, really excited about having her first baby. I'm trying to be less judgmental and filled with more grace.....