Sunday, March 28, 2010

A Bundibugyo Evening

Life here is simply not predictable.

Saturdays are busy - projects, football practice or games, streams of visitors and requests. It's also generally the night when all the singles have dinner at the Myhre's, which is always something to look forward to. I was late for dinner because I was trying to care for the Pierce's former dog Jessie, who now lives on the mission and has had a really nasty open wound, so I ran back to my house splattered with dog blood, showered, and ran up to dinner late (for the record, Jessie is improving greatly). When I got there, Scott was seeing a patient who has stopped by, so I took the meat and threw it on the grill, while Jennifer and the girls finished preparing everything else. We ate a wonderful dinner, as dinners at the Myhre's usually are, and we had just begun discussing what movie we would like to watch when Scott told me that a patient we had seen earlier was back and in need of care.

This old man needed a catheter, so we set up a relatively clean area on the ground in a small building next to the Myhre's house, sterilized some implements, put on sterile gloves and inserted the catheter. Nothing happened. The second try also failed. Since by this time it was 10PM, taking the man to Bundibugyo hospital wasn't a good option as he probably wouldn't be seen until morning, not to mention that the 30 minute drive over bumpy road would be sheer agony for him. So Scott decided to do a procedure then and there. He sterilized some surgical instruments, injected a local anesthetic, and proceeded to cut open the man's abdomen, stick a catheter directly into his bladder, and stitch him back up with the catheter still in place. Remember that this was late at night, so the only light he had was my headlamp and another flashlight being held by a neighbor of the patient. I stood by hoping, probably in vain, that I was being helpful, holding instruments and keeping light on the procedure. Just to review - surgery, blood, urine, on the floor, in the dark - but still well done. Scott told me I'll be horrified when I look back on this in medical school.

The degree of this man's previous discomfort became clear when, after all of this, these unpleasant procedures, this surgery with minimal local anesthesia, he looked at Scott and said "God bless you Doctor." Scott injected his thigh with an antibiotic that is apparently quite painful, and his parting words to us were, "You have killed my leg." After all of that, it was his leg that we killed.

It was 11PM, still terribly hot, and we were both wound up and not really ready for bed, so Scott, Jennifer, and I watched an episode of Prison Break, and I went home around midnight. I found my fridge out, so I had to hook up a new propane tank, light it, and take my second shower of the night, heading to bed at 1.

Animal care, grilling, tacos, surgery, TV, refrigerator maintenance - an evening with a bit of everything. Jennifer asked to me, "Won't it be boring to go back to a place where these sort of things aren't normal?" It seemed like a half-joking question. And my answer would have to be a half-joking yes.

Friday, March 19, 2010

Kick Off

We had our first football match of the season on Wednesday - it was supposed to be Saturday, but other teams are protesting and causing trouble, a frustrating story that I don't have time to relate now - always a big and exciting event. Especially in the last few months I've been spending a lot of time training the boys, usually at least five days a week for a couple hours. We have talent, and my goal is generally to bring some organization and tactical awareness to the game. The game started a mere two and a half hours late (we had to wait for someone to come and officially commission the match, but he needed to be picked up and driven to the field, and once he arrived he had to lecture everyone involved on the minutiae of the regulations. The bureaucracy here is mind-boggling), but within a minute we were off to a good start with a 1-0 lead. I was really happy with the way the boys played; they have come a long way since I first saw them. Like any coach, I was still frustrated with a lot of things and did more than my fair share of yelling - I wonder what the boys were thinking as I was screaming while we had a 4-0 lead - but it was a good match and was fun to watch.

Football season seems to bring the school together in a special way, and the joy that these boys have in representing their school and being supported by their classmates is clearly visible. Students and young children run onto the field after each goal, dancing and twirling in celebration. The girls beat drums, sing, and chant for the entire match. I think that the matches are a really encouraging experience for the players, and I hope that it's a chance for them to learn teamwork, dedication, and respect.

The game finished an impressive 6-1, so everyone was happy. Except for me, of course, as I was disappointed that we allowed a goal. But it was encouraging start to the season, and I'm hopeful that we'll have a successful year.

Friday, March 12, 2010

Hope


Kabasa went home today. He was admitted for about 6 weeks, and for the first three of those it continually seemed as though he was dying. He came in as a weak, malnourished child, swollen with edema, whose skin was falling apart and who lacked the strength to stand or even cry very much; he left today a happy, energetic boy with a little meat on his bones, running around the ward, throwing his ball to me, with a heartwarming smile on his face. Six weeks, from the very brink of death to curious, playful life.

I don't know what awaits him. At home, he won't get the same high quality milk and food that we can provide to the inpatients. Who can say what his future holds?

Still, Kabasa gives me hope. It is easy to despair in this place, but in the face of suffering, tragedy, and loss, he is a glimmer of beauty. A little boy saved from death. A life preserved. A father spared the loss of his son. I know I have said this before, but I'll say it again - because Kabasa is walking home today, a healthy boy holding his father's hand, I feel that the world is more right than it was yesterday. Undoubtedly, the world has a long way to go - several children this week have demonstrated that in gut-wrenching ways - but Kabasa gives me hope in goodness, wholeness, and healing.

"He will wipe away every tear from their eyes, and death shall be no more, neither shall there be mourning, nor crying, nor pain anymore, for the old order of things has passed away."

Sunday, March 7, 2010

Tuesdays

I realize that I provide very little indication of what I actually do on any given day, so here's a glimpse of Tuesday, usually a very long, intense day primarily consisting of malnutrition work.

In the morning I go the health center to do rounds with Jennifer, starting with the severe malnutrition cases. A few of the kids on the ward now:

I first saw Asaba at one of the outpatient programs, and immediately referred him to the health center for the inpatient care that he needs. He's been a troubling case, not responding to receiving the therapeutic milk in the way that we usually see these kids recover. His weight is starting to trend upward, so I'm hopeful that he's finally on the right track.


Tumwine is absolutely pitiful, one of the worst cases I've seen since being here. His body is wasting away, every rib, vertebra, and most other bones are clearly visible, and he is so sick that he has little appetite for the F100 milk that UNICEF supplies to us, so he is another sad case of someone who made it to the health center, but can't seem to turn the corner. Jennifer has said numerous times that she doesn't expect to see him alive the next day, but he has somehow clung to life. Part of his problem is child spacing. His mother just gave birth days ago, so she had stopped breast feeding him during her pregnancy, which was too soon for him. It's painful to see him in such a horrible condition every day, but somehow he's held on, so I try to keep my hope for him alive too.

Finally, a happy story. Kabasa is an object of wonder for me. He's been admitted for a long time, and wasn't responding for several weeks. His protein deficiency had caused major edema, and his skin was deteriorating. About three weeks ago, I said to one of the nurses, "He's going to die by tomorrow. What can we do differently?" Since then, this seemingly hopeless case has been a miraculous recovery. Within days he started smiling, and by now his weight it shooting upward and he's a smiling, playful five year old boy who gives me an energetic high-five whenever I see him, and loves to throw a ball back and forth. Every time I look at him I'm amazed, he brings joy to my day and hope to my heart.

On the first Tuesday of the month we have our motherless program, which supports caregivers to be surrogate breast feeders for children whose mothers died in childbirth, so in the late morning I see these cases. We give beans every month to nourish these heroic aunts and grandmothers, so that they can be strong enough to provide breast milk for these unfortunate infants. Some of the kids to great, and some don't; some families are incredibly dedicated to caring for these kids, while some don't seem to be very invested and are probably looking for any handout they can get a hold of. But I'm always amazed to see aunts, already breast feeding their own child and often struggling to provide for them, taking on the responsibility of caring for another child, or grandmothers who haven't had a child in years but have managed to re-lactate, these wrinkled old women who throw 25-pound sacks of beans on their backs, strap them across their foreheads, and walk slowly, steadily away, perhaps having to cover many kilometers to get back home.

In the afternoon, I jump on a motorcycle with Baguma and head out near the border with Congo for the BBB program, an outpatient nutrition program. The road is always an adventure, especially with the recent unusually heavy and long lasting rains. Their used to be a bridge over the river we have to cross, but it has been gone for years and now the motorcycles drive across when the water is low enough, and men ferry people back and forth on their backs.

Here are some of the kids from the BBB program.


Some do wonderfully on the locally produced peanut paste and soy flour that we distribute, while others don't respond well, but outpatient programs will always have those issues. It's been a great learning experience for me, and I've encountered many interesting cultural issues. For instance, one of the big difficulties with these types of programs is that it is culturally almost impossible for a parent to give a certain food to one child - the supplemental food that we provide, in this instance - without sharing it between all of their children, meaning that often the malnourished child enrolled in the program might not even get the majority of the calories that we give them. But I've had great experiences, worked with some wonderful kids, seen spectacular recoveries, and have built a great relationship with Baguma.

We get back sometime around 4 or 5 usually, and I run down to Christ School for soccer practice. The season starts next week and their are high expectations, so we're training hard every day. After two hours of playing, drilling, talking, running, yelling, and encouraging, I make my way back up the road around 7, with the sun setting behind me, tired, thirsty, hungry, and aching, but usually it's a good ache.

Wednesday, March 3, 2010

Media Darling

A quick follow up to my previous post about the camera crews buzzing around on the pediatric ward. A couple of days ago I received a text message from a friend in Kampala saying, "I just saw you on TV! It was about malnutrition in Bundibugyo." I'm not sure who thought I deserved to be on the news. Maybe I have the look that Ugandan news outlets are looking for. I'll call it fame.

My friend was concerned about Bundibugyo - are things really getting that bad? Is malnutrition on the rise as dramatically as it seems? The answer is no, it simply hasn't been reported before. Certainly, the rapid population growth coupled with increased cash cropping aren't helping the situation, but it's simply a case where things have been bad for a long time, but only when the WFP pours resources into the area does it get covered.

It makes me wonder how much of the world is that way. How many horrible situations, how many tragedies, how much oppression are we blind to simply because we don't have the time, energy, or desire to know about them? Maybe it's simply that news networks don't show it, or maybe we would rather be ignorant. But if even many Ugandans have little idea about the severity of malnutrition in their own country - granted, in a remote district - how much do we miss? What might our world be like?