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

Wrecked

Yesterday Josh preached a sermon about identity in Christ. The focus was on II Corinthians 5:11-21. But we also looked at II Cor. 6:1. I'm a fellow worker with God. A co-worker. Working together with Him. This particular thought grabbed me. I decided to meditate on it a bit this week. Prayed about seeing myself as God's co-worker.
So today.... first phone call for help at 4:30 am. Judith, an expectant mother with a hydrocephalus fetus. In labor. So ran out to the village, found her (a challenge all by itself) and  transported her to the hospital and got the c-section ball rolling. Mostly. Bethesda was a bit slow that time of the day but good FHTs and not super active labor so I tried to just take it easy. At 8am picked up Rachel and headed back to the clinic. 20+ prenatal women with a teaching session. Also a child with a burn, Kristine Emeru, two other kids, mouth sores and pneumonia. Another adult or two with general complaints.  One of the new mothers was fifteen years old. Makes me nauseated. One of the women was in active labor and wanted to go to the hospital. Another mother I couldn't get FHTs on. Got a call from Dr. Elisabeth around 12:30 to please come back quickly so packed up the two mothers who needed to go to the hospital and we headed back to Bethesda. Judith's baby had arrived. Very complicated. Very sick. Not breathing well. Cleft palate on top of the extreme hydrocephalus. Finger and toe deformities. Who knows what else?

Meanwhile got a call from the surgeon in Kumi (and several from Joyce and family) that they were not going to do surgery this week and she needed to be discharged. So ran out and picked them up. Came back and headed straight back to the hospital. The mother who I couldn't get FHTs on was just sitting in the waiting room. So I tried to figure out what the plan was for her. IUFD. Induction tomorrow. Discovered she didn't know any of this . So sat and had to tell her the baby had died. Explained the plan and maked sure she had the things she needed to get through the night. Tears just rolled down her face while she tried to hide them.  Then I went to check on Judith. Awake and alert. Asked what she knew about the baby's condition. Almost nothing. So tried to break it to her gently. Went over to the nursery, discovered the baby was completely alone.  The staff had been totally unable to get a line in. She had knocked her oxygen off and thought her breathing was a bit better, her sats were still low on room air. She was also quite cold. I asked Judith if she wanted to hold her and then carried her into the postpartum room (where there are currently three patients plus Judith) hoping they would do a little skin to skin.

Poor Judith was shocked and horrified at the condition of her baby. I guess I wasn't frank enough. She told me she didn't have the strength to hold her. I convinced grandma to hold her for a second but she didn't want me to remove any of the blankets. Practically every other woman and their attendants in the ward (of which there were many!) pushed their way through the curtain to see. Everyone made comments to Judith. (Most in Ateso so I don't know exactly what was being said). I could tell Judith just wanted to cover her head and cry so I told them the baby needed to go back in the warmer and scooped her up and took her back to the nursery. Even I wanted to just cry. This poor little child just needs to be held by her mother and loved for her probably limited time on this earth. At this point it was after 5pm. I was mentally, physically and emotionally done. Just done. 12+ hours, lots of grief and loss, lots of significant decisions, too many miles of driving. So I tucked the little baby girl back in, promised all of my hospital patients I'd be back in the morning and clocked out.
This was my day of meditating on being God's co-worker. Seems like I could and should ask God what the heck He was trying to teach me today but instead I'm just going to call it a day and go to bed.

Quick update on Joyce

This afternoon after church I ran out to Kumi to check up on Joyce. The good news is she is in good spirits and having a lot less pain. However there is lots of bad news: She is not actually in traction. She says it hurts when the leg is pulled so she just slides down in the bed. Which, in her defense, it is the dumbest traction I've ever seen as it isn't really attached to her leg with anything except the gauze that was put on days ago when her leg was swollen twice its normal size anyway. And because it isn't weighted, just tied to the bed, all weight can be taken off without Joyce even realizing.
Also, a doctor hasn't even seen her since I dropped her off Wednesday. I asked for his phone number, called him and he said he was rounding tonight (after 6pm) and I could wait and see him then if I wanted. He said he thinks he'll operate tomorrow but he isn't sure as he has not seen her yet and he has a whole week's worth of patients waiting so he isn't sure how many he will get to anyway. He told me all of this frankly, as though it was my fault for bringing her in when there were no doctors working at the hospital.

Lastly, I asked the nurses about paying because I know they won't operate without some payment and I'd hate for that be be a reason to hold things up tomorrow. They told me they don't know how much the surgery will be yet as the doctor is the one to determines the cost. They also confirmed that they won't even consider her without 1 million deposit. I told them I was willing to make that deposit and they said I can't as the accountant doesn't work on Sunday, I would need to come back Monday. I explained I was also working Monday and wouldn't be able to come back and asked what should we do? They said "No problem, surgery can wait until Wednesday" (which is the next operative day. I guess Tuesdays are for resting after operating on the forty waiting people on Monday.) I love this job. 

All poured out

Four requests for help before 9am. First a phone call well before 7am. Judith, a pregnant woman from prenatal clinic Monday, who needed an ultrasound. I had set it up for her (for free) on Tuesday but she missed the appointment for some reason. I tried to call her the day of the missed appointment but her phone was off. Today she called asking me to set up a new appointment for her today, and this time I should come pick her up she said. Second request for help, Vicky pounding on my gate at 7am on her way to school. Her mother was supposed to come to school to sign some forms but she didn't do it before she went to the village and now the forms are due, can I please some to school and sign them? Shortly after this I was headed out and discovered my truck wouldn't start. This has been an ongoing problem as I have an electrical short somewhere and the work around has been that I just have to unhook the negatives on both batteries before I let it sit more than an hour or two. But last night I was tired after a very long day and a hospital run to a different city and just forgot. So dead this morning. Headed into town with both my batteries and I on the back of a boda to get them charged. Got a phone call from the family I dropped off at the hospital yesterday (see last post), can I please come back and bring them some things? (More than an hour round trip).  Right around 8:30am I got a phone call from Obule that there are several sick people, can I please come see patients in the clinic today? (Thursday is not my clinic day and there are two other staff who should be working today and the person calling has called me more than five times in the past week for various problems.)
I explained to Judith that she should be able to take care of her own transportation but I'll meet her at the hospital. I promised Vicky I'd come to school take care of her mother's paperwork before the end of the day. I explained to Joyce's family that there was no way I could make another trip to Kumi today and some other family members would need to step up and help them but I would provide some money for transport. I asked the person from Obulle to please stop calling me.  Oh wait, I just wanted to. I didn't actually say that. I told him I couldn't come out today, that I'll be back in the clinic Monday.

I don't like saying no. I really wish I could help every person who asks. But I just can't. I kind of wish the people making requests of me knew how many others are asking requests of me. They might be more understanding when I have to say no.

I wish people didn't have so many expectations of me. Like that I can drop everything and come back to Kumi because they didn't bring all the things they needed the first trip.

Back to Judith, my first request for help today. We got her the needed ultrasound, and confirmed she is 36 weeks pregnant. She has been trying to get pregnant for years. Being "barren" here is considered a curse. Practically all of a women's identity is in the number of children she produces. Judith is 37 years old and has miscarried many times. She didn't have any early prenatal visits because she was sure she was not going to maintain the pregnancy. But she did. So at 35 weeks she finally came in for a visit. I found a heartbeat without difficulty but beyond that the exam was abnormal. Anyway, today's hospital visit confirmed that the baby has profound hydrocephalus. Judith just sat and cried when I tried to explain it to her. She is scheduled for a c-section in two weeks and I promised that we will do all we can to get the baby to the neuro hospital in Mbale after she delivers.

This job is hard. And I feel like I've got little left to give today. Time to head back into town to see if there is any way I can get my truck back.....

Joyce

There are a few things that have the power to really ruin my day.  When my truck isn't running well and I just don't know what to do about it (or just can't spare the DAYS it will take to get it working again).  When I waste an entire day trying to get some reasonable care for a patient. When the people I'm interacting with are being lazy or don't have any common sense. These things drive me crazy more than most challenges here. Unfortunately all three of these things converged on this day. It is seven pm, I've survived the day but I am just weary. I'm eating my first real meal of the day and headed to bed very shortly.
But first I wanted to ask for prayers for Joyce. She was hit by a drunk driver last night on her way home from school. This is the last week before they take their PLE exams (which determines if they can go to secondary school or not) so they stay at school until after dark studying. She could have been hurt much worse but she has a displaced femur fracture and a tibial fracture. We spent far too long getting this diagnosis and trying to get an ortho consult. Finally we packed up and headed to Kumi, a near by town which has a large orthopedic hospital. But no surgeon there either. He'll be back Monday.

This is us in the back of my truck feeling lots better after 1mg IV morphine. 

So she is about to spend the next four days in traction waiting for surgery. She has a lot of pain and she is frustrated because she will have to repeat P7 as I've learned there is no way to make up this test. For any reason. No matter how valid.


10/27 Addendum- I went to her school today to beg for a makeup test date. They said there was absolutely no way as the test is administered by the government and it just is not possible. Their suggestion was that if Joyce can have the surgery Monday I can bring her back to Soroti that night and she can still take the tests Tuesday.  Less than 24 hours post-op. That seems like a great idea. So when I was at the hospital I was just discussing with the Ugandan nurses and they confirmed that there was no way to miss the test. Their idea actually was that I go get her now, have her take the test and bring her back for surgery the day after she finishes. A displaced femur fracture. That also seems like a great idea. Are you kidding me?!?

I have an idea....

Barbara on the left with a new mother and baby

We have an emerging challenge at the clinic in Obulle. The midwife, Barbara, has been working there about 7 months now and word has spread that she does deliveries. (The clinic didn't used to do them. The nurse provided prenatal care but people either got transport for the 20km into town or delivered at home.) They have also discovered that if something is wrong I'll get them free blood work or an ultrasound if needed. I also have been pushing prenatal visits and giving a free "moma kit" (supplies need for birthing like soap, gloves, etc with a little onsie and blanket) for the third prenatal visit they attend. Well, this has brought in several mothers in labor, trying to get their free baby things in a third visit before delivery. And just a lot more pregnant clients overall. Which is a good thing. That is what the clinic is there for. But this means we are having more and more deliveries. And more and more mothers coming for prenatal visits. I'm not complaining. But clinic days are becoming increasingly stressful for me. This morning we were trying to assist two laboring mothers while doing more than 40 prenatal checks. On one bed. With only two of us staff. Then suddenly there was a bad second degree perineal tear that I spent far too long trying to put back together and the day just seemed to get away from me.

And now I'm tired.  And Barbara is too. But we are expecting three more deliveries this week. Which leads me to my idea.
I'm seriously considering apprenticing a young lady or two from Obulle and training them to be assistant midwives. Young women who don't have their own kids yet so aren't too tied down. Who are functionally literate and can read our charts. Who are trainable in basic skills like fetal heart tone monitoring and blood pressures and who can support laboring women in the clinic. They will need lots of training before they can be independent. But I think they will really be of benefit to their community.

This post actually started out as one of the ones where I'm just writing to myself to process out loud. But I decided to clean it up, add today's pictures and toss it out there to ask for you to pray over this idea with me. I see lots of potential problems if this idea is actually going to happen. First off anyone who fills this role will need to make a small stipend. Which means I'll have the challenge of hiring and managing people. This will change my status in the community. Also, the local government officials may not like it because they would rather we just hire another district midwife. Which I don't want to do for so many reasons. An "apprentice" is a much more logical fit. But it will need to be the right person or people. There are lots more potential problems but the idea makes me quite excited. And slightly less tired already.....

Water

So, it seems like whenever I'm in Karamoja a water post soon follows..... 

Alakas used to have a capped spring well for clean water. But has dried up. Now they go further "upstream" (it is an underground spring) to get water from this dirty mud puddle. This wont last long for the number of  people and animals accessing it. Then they will have to set off again searching further and further away. 

Also, Lormoruchbae's spring has dried up. They say they don't even bother hiking up there any more. The good news is Water Aid put in a new borehole but they stayed far from any of the land UWA is claiming so the people of my village walk nearly four miles. That is a minimum of an hour of walking and most families will make that trip several times a day. And carrying water is hard work. And the animals all have to be herded out there. It seems like these guys just can't get a break.

Kidepo

I had a chance to visit Kidepo National park. It is topographically stunning and I highly recommend it to anyone who has a chance to get up there. It is very remote and as far north as you can go in Uganda, bordering both S. Sudan and Kenya. We stayed in tents in a campsite and heard lions in the night. Unfortunately, a large number of the animals have moved out of the park right now so we didn't get to see much but it was peaceful and a nice night away. 

Buffalo, zebra and jackal, giraffe and patas monkey. Unfortunately no elephants, lions or cheetah (which is what this park is known for) but I guess that just means I'll have to go back another time.

Deworming in Karamoja

Last week I was up in Karamoja with some missionary friends. I've been wanting to do a de-worming campaign for a while now (here is the rational if any of you are interested in that kind of thing) and finally managed to do it. We had to hike out to Alakas as the road is completely spoiled and my teammates were troopers in the 100+ degree heat on what is not really an easy trail.

But we managed and were able to treat nearly 200 children. We also delivered two boxes of meds and testing kits to the VHT.

Later in the evening we reached two more villages and we also treated Lormoruchbae (where we were staying) so all together we treated more than 400 children and more than 100 pregnant women. It was a full two days but it was good to be back in Karamoja and good to have friends to work with.