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. 

Mary and Melda

I only have a second because I'm headed back out but wanted to post a prayer request for sweet little Mary. She was born HIV positive so her parents abandoned her to her grandmother, Melda, when she was still pretty young. A few weeks back she started developing symptoms and Joint clinic diagnosed her with malaria and sent her home. Yesterday, members from my church asked for help as she had gotten much worse. She is now unable to sit, even swallow and has pain everywhere. She was having severe, practically continuous muscle spasms. Tetanus.  I rushed her into the hospital here in town and we started as much supportive therapy as we have access to, but there is no treatment.

We have her as sedated as possible to reduce the spasms but we need her to keep breathing, which is a challenge. When she is awake she is perfectly aware of what is going on but is "locked in". She can't move, can't swallow, feels like she can't breath.
Yesterday, Melda asked the translator to ask me to please keep Mary alive as she is the only family she has left. Tetanus is often fatal here and they know it.  We need a miracle.

more about Joyce

"Sterile" dressing changes and pin care daily for just a few more weeks......

Nursing friends- have you ever wanted the opportunity to do sterile dressings in your front yard?! Come on over to visit and I'll give you the opportunity!

Weekend in Karamoja

Always work to be done in Lormoruchbae. Harvesting sorguhm. Carrying it literally miles from the garden to the village where it is dried and stored. Happily they are getting a pretty decent harvest. 

 For fun I brought a huge watermelon up and after several hours of work it was a refreshing treat that many enjoyed. No one had ever tasted watermelon before and they were sufficiently impressed. It was tough convincing them not to eat the rind.

Just a few things I've read while laying in bed

I know that I've told myself before that I'm not allowed to post when I'm feverish but it seems the thing to do right now. I just have a few things I've been underlining as I was reading this week. I'm not doing any analyzing, just laying it out there.

We all desire to lead safe, comfortable lives. We may deeply desire to follow Jesus but what about when He leads you to a place that requires risk and sacrifice? - Not a Fan by Kyle Idelman

In another book I'm reading "Paddling the Pacific" by Paul Theroux, he spends time in many remote villages of thatched huts. But he comments on the fact that it make him worried so he doesn't stop in villages that have "tin roofs and cinder blocks, sheds with padlocks that aid agencies built in the innocent belief that they were doing them a favor."  He says he has seen for himself that "..such dwellings and such violated villages are unpredictable, full of nuisances. Villagers living under tin roofs stenciled  A gift from the people of United States of America, and eating food aid, regarded people like me as a soft touch. I was all for foreign aid, but there was a certain type of aid that undermined people and made them dangerous."

Here is another one I've spent some time pondering after reading because it is a different perspective than what I currently have. When I think I'm too tired, frustrated, or can't bear up anymore....

If God asks me to suffer something for a period of time, could I say with conviction,'We know that in all thing God works for the good of those who love Him and have been called according to His purpose'- or would I grumble and wonder why God let it happen to me?  Could I thank God for trusting me with the experience, even of loss or severe hardship or illness, and seek His grace to learn more of Him through it, so that I in turn could help and encourage another- or would I demand release or healing or escape, thinking of such as my 'right' because I am a christian? This attitude of heart and mind, that can joyfully trust God in all circumstances, can only take possession of me as I allow the Holy Spirit to fill me with love for my Lord.   - Living Holiness by Dr. Helen Roseveare

The last book I'll mention this post is Faithful Women and Their Extraordinary God by Noel Piper. It is five brief biography of women who impacted the kingdom in amazing ways through their faith and obedience. I highly recommend it even though it is making me feel extremely inadequate.

Updates on Joyce and baby Anna

Baby Anna is in the Neuro ICU in Mbale trying to get stable enough to go to surgery.  They have postponed it three times and now we've heard maybe next week. But her ICPs are increasing and she is having more and more neuro symptoms. Please pray for her and for peace for her mother.

Joyce did actually have surgery Monday. However they did a mediocre job at best.  They plastered over her incision and even incorporated the pins into the plaster.

So with the help of a PA in Soroti who owns a cast saw, we cut off bits of the cast so that we can do wound care.

Just a little hail storm

OK, actually a lot of hail. Killed two of my chickens and I needed to resuscitate a few of their babies. But they pulled through because of my tremendous medical skills. (But mostly because of the oven and a few kitchen utensils.) 

Too much

This week.... seriously, I don't have words. I've had more patients inpatient all at once than I've ever had before. Teammate, Steve Tiesenga needed to be Med Evac'ed to Kenya for critical respiratory issues post malaria. 

I did manage to get the mother who was c-sectioned Monday discharged. Also, the mother who had a fetal demise at 8 months had a huge blood loss after a 12+ hour induction so her discharge was seriously delayed but she is also finally home. Baby Anna (the baby born with profound hydrocephalus) I took to a neuro ICU in Mbale yesterday. She was hypoxic, hypoglycemic and hypothermic by the time we finally got her admitted so I'm glad someone who has more resources than I do is taking care of her now. Joyce will be readmitted tomorrow for surgery Monday.

Baby Anna