#11 HOME SWEET HOME….

Thursday, February 21, 2013

I arrived home to Portland, (note I said “home”) last Sunday around 3pm, to my car in the long term parking lot with a key waiting for me. It was weird greeting “myself” at the airport and coming home to an empty house. It wasn’t completely empty though, there was a beautiful bouquet of roses with a lovely valentine from Jeff and a special valentine from Liam (more on that later). Jeff had left for Cambodia the same day I left Uganda. So we were both flying out of international airports on opposite sides of the globe but it’s where God has intended us to be, without a doubt. It’s a weird transition we are in, and we’ve decided planning back to back trips like this where we are apart for 6 weeks is NOT the best plan. I was supposed to be with him for his trips to Guatemala and Cambodia but Uganda was “calling me” and I just had to go… 6 weeks is a long time, but thank God for FaceTime, texting and Skype, for we got to talk almost daily via one of these wonderful gifts of technology. With Jeff’s new role at MTI, I’m in a new light and trying to figure out how I can be just an ordinary volunteer and not “Jeff’s wife”. Fortunately, few people in Uganda knew who I was, and we wanted it that way. Plus there would be added security risks, which I wasn’t looking forward to. I’ve waited to type about this until I was at home. All went well though and I just got to be “Nurse Janey”, which is what I do best. I’m not much for formalities and am a bit dense about them actually.

My first 24 hrs home I basically stayed in my PJ’s for 2 nights and a day.  This is a luxury I don’t normally do because I’m more motivated to unpack and be settled at home when Jeff is there. But who would know?  (besides all of you now?)  I decided being organized is for the birds and just “being” is what I needed to do. I spent a ton of time on the phone connecting with loved ones, and absorbing being home… I read… At one time I walked into my ridiculously large walk-in closet and just stared at it. This closet (which we didn’t design, but obviously came with the house) is larger than the room I lived in for a month, AND larger than the square footage the Congolese families lived in. I tear up typing this…  how do I reconcile this? What does this mean? I actually like this closet now, but should I?  It certainly is NOT a need but it is open and is easy to organize. I remember Nurse Deana on my last Uganda mission, teaching me that in her wisdom of 20 or so missions, her home in Idaho was not going to fix all the problems in Africa. She counseled me numerous times on this, that it was ok to have what you have here but it needs to be kept in perspective.

Perspective. Something I’m still working on…

Ants. I have ants in my new house. I hate ants and the pain they are trying to figure out where they come from and how to stop them. Plus my counter tops are like camouflage to a little black ant. But the bright side is that when I opened my coffee cupboard and discovered them in my old fashioned clear sugar jar, I giggled. They made me feel “at home” because I had constant trails of them on one of my walls in my hotel room. The ants were my greeters. I do still hate them though, despite the giggles.

My coffee pot.  I love my drip coffee pot and so looked forward to my first pot the morning after arriving home…  The pot failed to stay on and I giggled once again. I found out later it’d been being temperamental for Jeff while I was gone. Fortunately I had some more VIA packets to make a cup of coffee for the morning. “Fortunate”, what a stupid word here, like I who had been with refugees for a month would be “unfortunate” to NOT have brewed coffee one morning. How silly. Jim and I savored those VIA’s most of the mornings at the hotel, as I’d brought a great stash to share with him. It was better than the instant that is typical for Uganda. My cup of VIA once again took me back to the hotel mornings…  my re-entry is going well so far.

Piano…  Chelsea and Casey’s beautiful black piano is being babysat in our great-room until they have space for it again, soon. This piano has been being played more than ours was the past 5 yrs in our old Issaquah basement. It was therapeutic to sit and play worship songs to my Lord in the quiet of our home. This was peace for my soul having been where I was. My world is so different than the one I served in for a month, yet I was born into my zip code not by any doing of my own. In the end we will all be together in Heaven, those who follow Jesus, and it won’t matter what zip code we came from, but what we did with that life we were given in that zip code. This music was a salve to my soul.  I could play and sing (with much error) and it mattered not…

Pound cake, more like kilo cake…  Our last clinic day Jim and I had ordered 2 custom cakes, one for the MTI staff at the end of clinic, and one for the sweet hotel staff that lovingly cared for us each day at the tiny hotel. Every African cake we have ever ordered for a party tends to be on the dry side (baked in a hot propane oven?), very heavy (thus “kilo” and not pound cake) and the frosting is full of dye and chips when you cut into it. BUT the staff feel so special to have a cake decorated just for them and this is the take away… feeling special. A case of soda pops, a cake and you have a party!

I’m randomly going backwards toward the end of our trip, my mind is a bit scattered with being home and being there, plus I waited too long to write this…

The last day’s clinic was a bit stressful. Translators were hard to nail down and there were some other frustrations… and lots of malaria. We’ve tried to make things go a bit smoother and to set in motion a more active role in the camp by walking through the 3 tent “villages” in the morning to round up sick refugees, but in reality we don’t have any idea if the next team will do the same. Jim has said a few times to me “The new team is gonna come here and wonder what the hell we did for a month!” I agreed! Creating change is hard, and for this staff who gets 2 new volunteers per month with their bright new (and not always realistic) ideas, how do you implement something that will stick? The camp size changes…  acuity changes…  patient load at the nationals clinic is more & more demanding… the government doesn’t replace staff so that the burden falls on MTI…  We hope that somehow our time here has not only helped those patients we’ve cared for, but has served as an encouragement to the staff who are on the front line day in and day out…

A delightful find last clinic day… I think I wrote about the 2 yr old who was in a coma at age 1 for 2 weeks due to meningitis. I had given her physical therapy instructions for her toddler to strengthen his legs since he stopped walking with the meningitis and momma had basically had him strapped to her back for 14 months. On my morning walk through the camp I finally found the mom again and asked her to come back to the clinic. She was to come weekly but obviously needed a reminder. Her son was actually able to take steps now with some minor assistance from mom’s fingers to hold on to. His feet still rolled in some, but were improved. He was such an encouragement to see and both Jim and I were pretty confident he was destined to walk! Thank you Lord for that glimpse of hope.

Siffa… as we pulled out of the clinic drive anxious to start our 4-5 hour journey to Mbarrara, I said to Jim that I hadn’t said goodbye to Siffa. I felt horrible about this. I think I told her the day before that we would be leaving, and that another team was going to take good care of her, but I feel like we just disappeared. Period. My concern is that she’ll feel abandoned by our love and attention. Jim was very encouraging and positive (as usual) and told me we’d given her good attention throughout the whole month and that she felt loved by us every day we saw her. Thank you Jim… I have no idea what goes through a refugee’s mind on something like this.  Maybe it’s an American thing to feel slided or abandoned by your expectations. All I know is that I would do that departure differently, had I the chance. All I can do now is pray for her and hope that the replacement team falls in love with her too.

Jonathan… I passed on my pulse oximeter I’d purchased for the mission to Jonathan, the nurse that is basically the senior medical person for MTI there now (until our volunteer team arrives). It was kind of like handing him gold. I think he was honored to have such a tool that could tell you how much oxygen a person was getting, a gauge for how critical they are and whether to transfer them. He promised to share it with the new team but I asked that he be in charge of it so that it stays with the MTI mission wherever they may move. Jonathan is a wonderful staff person and I believe the star of the clinic.

After 2 days of car travel we were finally at the airport the evening of the 10^th. Jim’s flight was at midnight, ours 11:30p. We were waiting for Jim to come through security but when he did his face reflected MUCH disappointment. His flight was delayed until early am, but very indefinite on the timing. His wife was home alone on Cape Cod in a snow storm and without power. Needless to say he was SO frustrated with the delay and only wanted to be home with his wife. We later found out that a small private plane with a mom and her 3 kids crashed adjacent to the Brussels runway and this is why Jim’s flight was delayed. The airport had been shut down for the investigation. I was feeling guilty that maybe my flight should have been the one delayed since I was going home to no-one and Jim’s wife needed him. I never told Jim this, kind of a stupid thought since it’s not like I could twinkle my nose and switch places. The news of the crash brought it all into perspective and patience grew…

Mike and I stood at the glass window dangling our MTI ID lanyards in hopes of the new team seeing us through the glass. Dr. Jeannie did and she eagerly motioned me over to the open glass door that should not have been open. We were able to carry on a conversation about 10 ft away from each other (until I almost got in trouble) and exchange information on Matanda. She was wonderful, energetic and seemed like loads of fun. But best of all she had read our email about our key patients, especially Siffa, and she was going to follow up… It’s been 10 days now and no news yet, but I hope to hear something soon.

Luke has kind of told me I needed to post some sort of a re-entry blog for coming home, I kind of just dropped off. For some reason I’m so late in doing this for this trip. Not sure why… I’ve been picking away at finishing this blog entry but after I’d been home for 3 days I hopped on yet another plane to see Chelsea, Casey and Liam. What a treat it was to be with family and to be entertained by Liam who is so animated now. And what a contrast in the opportunities he’s already been afforded and the loving attention he’s able to receive because his parents don’t have to struggle to just survive. I found myself SOOOO thankful and energized by this gift of time with them. Jeff arrives home in 2 days now, YAHOO! And after 6 weeks apart we get to just enjoy each other this weekend and debrief. I’m so excited!

In closing this mission blog, tonight I went to part 2 of a lecture on spiritual warfare at our church. I’d listened to part one on the podcast so I’d be caught up for tonight. His talk was wonderful, very articulate and scripturally sound. (If interested, check out River West Church, February 13^th and 20^th)  He was explaining something that had referenced slaves and the history of slavery in different cultures. Then he read from Galatians 3:28 which says:

“There is neither Jew nor Gentile, neither slave nor free, nor is there male and female,                          for you are all one in Christ Jesus.”

My flitting mind went right to my little people in Uganda, the Congolese refugees who are in such a different situation than I… and yet, we “are all one in Christ Jesus”. My Jesus crosses the boundaries of this globe and binds us all together as one…

beautiful.

Love, Nurse Janey

#10 I THINK I’M DONE…

February 6, 2013

This is how I felt when I returned home tonight, but I’ll explain further in a bit…

The clinic day for me was steady and productive in the refugee camp. But for Jim it was the worst.  The volume of “Nationals” patients was just too great so he headed there to help out and in a few short hours he felt he’d seen about 50 patients, approx 80% of them having Malaria. At the end of the day he came bursting into the refugee clinic saying, “Janey, I need your help with a kid. She’s got a 106’ fever and I need help getting it down”. I was actually packing up so I picked up the pace and we headed to the inpatient unit. Jim was so frustrated on the speed walk there, he was so angry that this little one had been sitting for who knows how long with such a high fever, for there is no triage system in place and people just patiently wait… for hours. He said, “I’m so angry right now but I need to keep it together and take care of her. She could lose brain cells with this high of a fever.” In the ward the nurse was bathing the near 2 yr old with water, after having given a Tylenol equivelant and was now trying to get an IV in. The lab tech came to test for malaria and of course it was positive. Shockingly, the parasite count wasn’t that high but her fever reaction needed to be treated as severe. Holding her arms firmly for the IV, I found myself inwardly saying “I hate this malaria, I hate this malaria”… When we left she was getting the IV quinine that she needed. What would have happened if the clinic wasn’t here???

One of our hotel staff, Dan (28), has a cousin that has been missing since 1994, from the genocide in Rwanda.  His cousin was born in 1985, my Lukey’s year, and has been missing ever since. I think I wrote about Dan before, but I need to write more. He humbly cleans our rooms and washes our clothing, is soft spoken and kind. I have a hand written sheet with all the facts about his cousin Patrick, for he asked me a couple weeks ago if I might help him find his cousin in one of the refugee camps and I promised I would do what I could. He needed help and was so sober in his request. Today I brought the sheet to the UNHCR tent to ask if they had a way to put his name in the computer to track a refugee from 1994. The man said he could help me, but when I left the tent there was a new sign up, or at least one I’d never noticed before. It was a poster from the UN Red Cross for location of lost persons service, and it had a list of missing refugees they need help in locating. The list was for loved ones who had gotten separated in this recent crisis. Just imagine for a minute…  pause…  and wonder what it would be like to run for safety and be separated from your loved ones. It’s just too much to imagine. And when I read Luke’s birth year on Dan’s paper… it brings it all too close to home for me…

After seeing this sign I sought out the Red Cross guy Benjamin, and transferred the paper to him for helping locate the missing refugee. He promised to call Dan himself after he’d started the search process. When we arrived “home” the staff, as always, say cheerfully “Welcome back”,  with huge smiles. I was so excited to share the news of this  Red Cross service to Dan and handed him the brochure explaining the conversation and that he would soon be getting a call. He beamed and said sweetly “Thank you.” He was still on my doorstep when I opened my room and saw a photo of a man on my desk next to a small hand carved lion. I said “Where did this come from?” He responded, “It is from me, to thank you for helping me in locating my cousin. I have written on the back to explain everything.” So I turned over the photo and read these words, I can barely type them…

“Mother Jane, In appreciation of your kindness and tender mercy to accept to help me in finding my cousin brother Munezero Patrick, I give you this gift. Blessed be you and your descendants for prosperity. For the gift small, I pray that God bless you abundantly as Matthew 5:5-8 says. For my cousin’s recovery you can call my uncle direct…  (tel. numbers and emails)

In memory of me, I give you this photo. Thanks alot.

I request you to a friend forever or even a family friend if possible. From your African son, Namara Dan, Uganda.”

I hug him and am too teary to barely speak and say “Thank you”.  When I close my door this is when I quietly say aloud to myself

“I think I’m done, I can’t take any more.”

So I get out my bible and read from Matthew 5:5-8, which says:

“Blessed are the meek,

For they will inherit the earth.

Blessed are those who hunger and thirst for righteousness,

For they will be filled.

Blessed are the merciful,

For they will be shown mercy.

Blessed are the pure in heart,

For they will see God.”

Time to take a cool off shower and cry, it is just too much to receive…

Typing this now I think, surely YOU Dan, will inherit the earth… and will be filled… and shown mercy… and you will see God. This I am sure of.

After cooling off, Jim and I enjoyed a cold beer on our patio (the usual) and debrief from the day, and then I have to fulfill a promise I made…

Agabe, our sweet waiter, is a single dad of a 2 yr old boy who’s mother just decided to go away ???  The son is currently being raised by grandma while Agabe works hard at the restaurant. Everything is such a blur now, I can’t remember what I’ve written but I’m too lazy to go back to old blogs. One day a couple of weeks ago, Agabe presented me with a business plan. He’d written out all he needed to purchase to start a “snack store, like fried feesh, some cheeps, some meat on stick, you know… snacks”  he said.  Of course. His little proposal was so good and he was petitioning investors in his little business. He needed 800,000 sh. ($320) to get started. I praised him for his business plan and asked lots of questions before letting him know I just couldn’t invest in this because we are using our funds for medical issues here.  (How could we choose who to help here and who not, there is no end and we have to keep focused on our MTI work…) Agabe received my answer well and I then prepped Jim that he would be getting the same request, so he could prepare his praises and also his response. I have since been consulting to this little entrepreneur, (too funny because I am not one). I challenged him to think of what would distinguish his little snack store from others, why would people purchase from him before the competition? His wheels were turning.

Last week Agabe proudly walked me across the street to show me what he had started, even before all the funds had been raised. He’d hired a young girl to fry the meats and deep fry potatoes. The little hut was darling and had LOTS of potential, but for SURE would have been closed down by our health dept. at home. The location was perfect as he could keep a good eye on it across the street from the hotel. I praised and praised him for all he had accomplished, and then gave feedback of how he could clean up the little hut and prep it for painting, painting with high gloss so he could continue to keep it clean. He was so very proud. So I’d promised him I’d go to the paint store one day after clinic, and help him shop for what paint to buy.

Today was the day we could do it so we walked a few blocks to various hardware shops (tiny cubicle stores) to look for just the right paint. For some reason I had a lime green in mind (but didn’t tell him) and he bright blue. I was excited to see the paint chips or brochure choices. First store, there were 4 jugs of paint on the floor and that was it. No color mixing, no chip/brochure choices, no gloss to choose that would clean up well. What was I thinking? That we were going to Sherwin Williams, or Benjamin Moore, or Home Depot? I didn’t show my disappointment but said cheerfully, “Is there another store to look at?”  “Oh yes!” So the next store has about 4 gallons of high gloss enamel in different colors and many pint sized cans… too expensive. So we go to 2 more stores but I’m catching on that he may be getting the “muzungo” price with a white lady next to him. So I ditch him in a shoe/skirt store nearby so he can get a “real” price. Better, the price is getting better. So we walk home and talk paint, talk how to get good prices by bargaining (now this I AM good at) and we talk design and color choices that would make an appealing “snack” restaurant (Candy, I need you here). I create a scenario of him being new to this town and looking down this street along both sides. We pretend they are all tiny restaurants. If you knew NOTHING about them, which would you choose to buy food at? He doesn’t get it. So I create the scenario another way and it takes about 3 more times. FINALLY he looks up and points to a bright blue building, that to me has been popping out of the street scene since we turned the corner. All the other store fronts were dirt neutral colors and drab. NOW he gets it. He sees it looks bright… and clean… and inviting… and like the cook & owner care about cleanliness! YEAH, a break through and he’s smiling big.  So I’m NOT buying Agabe’s paint like I’d thought I would, and hopefully he wasn’t expecting it. I realize that yet again, how do we decide who to help out in this way. He has been given the gift of advice, counsel and encouragement. He is happy. For now I told him to take lots of soap and a scrub brush and scrub the walls clean.  Plus the paint will stick better when he can afford to buy it :0)

On route home he asked “Do you want to see where I live?” Sure. As we walked between broken buildings I thought “This could be stupid,” if I didn’t trust him and know that he cared about me. In the courtyard of broken buildings were 3 men dismantling a motorcycle. At first my heart stopped a bit, then I watched Agabe and he was unmoved. He proudly unlocked the door to his humble abode. It was about the size of 2 twin beds, was tidy (he was not expecting me), but dreary and dark. The walls were being wallpapered with leftover newspaper. He had me sit in the plastic stacking chair so he could take my photo. So sweet. It felt hot and claustrophobic but I needed to do it. The pride on his face of what he was doing, his job, his new business, his “home”, was so humbling. And all with the focus to give a good life to his two yr old son “Alpha”. I was humbled to be there…

Siffa, sweet siffa. Not such great news here, as last weekend her dad was resisting her being removed from his refugee registration form and insisted she be put back on his.  He was under the misconception that we’d given her money, and he was missing out. And also missing out on the extra supplies when you have more family members. Love, what about love? So Saturday I was disappointed to discover this but couldn’t handle an angry dad who was requesting her meds and forms be returned to him. We were afraid he might take her back to the Congo so I sucked up and told him we’d love her to come daily and are happy to keep all her records for him. He smiled and left. We felt the politics needed to wait for the commander who was gone for the weekend. So today he was back and I discovered that the UNHCR cannot enforce families to give up their children. I get that. But Siffa? He said the couple still agreed to help as long as they were relocated near them when the convoy moved the next 600 or so refugees. So we have to rest in this and continue to work with the dad as is. Jim prepared an extensive email to the incoming team in hopes that they may have new insight to her care and also hoping things don’t fall through the cracks for her. She’s complicated…

Tomorrow is our last full day and then Thursday we work until 1 or so before starting the 4+ hour drive to Mbarara. Tonight we had a lengthy but necessary debriefing with David Alula and the new administrator for the program in Matanda. We are hopeful that our feedback was helpful in bettering the program, but I’m now pooped. It’s been a long day from a clinic that was too busy, to a 106‘ temp toddler… to Dan making me cry… to paint choices/counseling… to debriefing. Journaling helps me keep the memories of what I am learning and experiencing here, and I hope it blesses those who read it. It’s been a great and challenging month, but I’m smelling the barn…  Jim told me the other night that he’d go on any mission with me, that he felt we worked well together and he would certainly do it again. Cool, that was so cool of him to say that. I told him I certainly feel the same. As they say in Africa,

God is good… all the time.  All the time… God is good.

Good night.

Love, Nurse Janey

Proud Agabe’s new “Snack Store”

 

 

The nursing staff model their new “smart” lab coats…. quite proud!

6 week “Failure to Thrive” infant who I was able to do 3 breast feeding sessions with mom in order to increase her milk supply, he’s gaining weight now

P.S. This was taken from our friends ministry website in South Africa, where they work with the townships empowering the church to come along side the people in need.  I simply love this!

Martin Luther King, Jr. on the Role of Religion in Society

“A religion true to its nature must also be concerned about man’s social conditions….                             Any religion that professes to be concerned with the souls of men and is not concerned with the slums that damn them, the economic conditions that strangle them,                                                                      and the social conditions that cripple them, is a dry-as-dust religion.”

#9 SIFFA HAS A NEW MOMMA AND DADDY!

January 31, 2013

Today was too good to be true…  This morning Jim and I discussed Siffa’s situation and how we need to arrange something better for her. When she relocates to the permanent settlement, possibly next week, she will need to be handed over to whoever runs the medical clinic there (if they have one) and also really needs a foster mom or family to watch after her. Her father has regressed in his care of her and she seems to be on auto pilot again… but stable.

This morning before we started clinic in the camp, I walked over to the UNHCR camp commander, a man who is kind of like a gentle “Great Santini”, a tall poised man who commands respect just by his presence…  kind of how I felt about my dad 🙂   I  approached him saying “Commander, I’d like to talk to you about Siffa. We talked last week about her needing a foster family and nothing has been done.”  He had compassion in his face and we talked about her needs and her father’s lack of care or capacity to take good care of her. He was amazing and agreed and said “We shall find a loving family for her, someone who can attend her at the hospital and take good care of her.” We have learned that good intentions are just that, usually good intentions, but that you have to be a squeaky wheel here and at least try (and in America too for that matter).

About ½ hour later I was summoned to his tent, kind of like going to the grand “poo-bah” (sp?).  I sat in the dark tent and saw a stoic couple sitting across the dirt floor with a Red Cross woman between them. No smiles. He informed me that these people have agreed to be Siffa’s parents, that they will welcome her into their family and take good care of her. They already know her well and live only a few tents away. He said that when they relocate to the settlement camp, they will move as a large family and all be placed together, the 2 yr old too. I was very excited to hear this but the faces I was looking at didn’t look too happy (concern… ).  I said, “The mom isn’t smiling, is she happy about this?”  He boldly said “Oh yes” and spoke to the woman who giggled a bit, more words exchanged and he then said, “She is very happy”.  Phew!  They have 4 children of their own, who looked very clean at 9am, kind of a lean daddy and chubby momma. Perfect. I asked how Siffa’s dad will take this, thinking Jeff would want to kill someone if they told him his kids were going to be fostered by someone else. The commander said, “He will be very happy, he knows it is too much for him to care for them.” Inside I have a tinge of wonder, thinking the dad might come after me/us and be angry…  The Red Cross person went to summon the dad and they had a meeting with the commander and the couple. While waiting, I told the parents that because Siffa has HIV, if she is bleeding they should use gloves but that the risk is mostly if they themselves have a cut or open sore for them to get contaminated. I explained more, they understood and seemed unconcerned. I returned to the clinic because I did NOT want to be there for the news. When dad and Siffa arrived and the commander spoke to them, all of them came smiling out of the tent and came over to me at the clinic. They were smiling and I was told the father was “so very happy”…  and Siffa was smiling too!  I had Jim take a photo of all of us and as they walked away toward registration to formally change the tent situation, Siffa straggling behind as kids do. I smiled and watched her as she tossed her plastic bag of stuff up in the air as if to celebrate. I called “Siffa!”  She turned and had a big toothy smile! I waved and when she turned I called her again “Siffa”… smile, and then again… same big smile. I couldn’t get enough of her happy face. She now has a loving family… and it was simply the BEST day. Jim and I feel so good about this outcome and the protection of her precious life. It was a worry for us. We have talked over and over about her case. We’ve had been planning how to pass her off to the incoming team…  done.

A bit later I walked up to the commander in a field and hugged him saying, “Thank you for finding her a home. So many people in the States have been praying for her and I’m so excited to write them tonight and tell them the news.”  He boldly said, “Thank you for being so appreciative, it is wonderful!”  He promised to call the commander in the new camp where they will move next week, so that he will check on her regularly. He also said he would personally check on her when he goes there. He will get the number of the Doctor who would follow her so that Jim can “pass the baton” to him. We are so thankful God has heard our prayers. Simply the BEST day yet!

Starfish… MB reminded me of the Starfish story in her blog “comment” after my sad day, “…it is good to remember the Royal Family Kid’s Camp’s motto… you know it, ‘It makes a difference for that starfish…. if even one.’ Sleep well and my prayer is that God will continue to give you some evidence of hope amidst the huge amount of pain and injustice.” Thank you for that sweet reminder MB, Siffa is evidence of that hope amidst this pain, and also evidence that as Hebrews 11:1 tells us, “Faith is the assurance of things hoped for, the conviction of that which is not yet seen.”  Amen.

Yesterday, more starfish moments…  Jim and I were confident yesterday was going to be a good day for both of us. Monday was a downer for me, Tuesday a downer for Jim, Wednesday had to be looking up, right? We worked together in the refugee clinic all day because the Nationals clinic had 2 clinicians and they were handling the work load fine. We had a lower volume day but meaningful patients… some “starfish” moments.  f you haven’t read the starfish story before, here it is:

“While walking along a beach, an elderly gentleman saw someone in the distance leaning down, picking something up and throwing it into the ocean.

As he got closer, he noticed that the figure was that of a young man, picking up starfish one by one and tossing each one gently back into the water.

He came closer still and called out, “Good morning! May I ask what it is that you are doing?”              The young man paused, looked up, and replied “Throwing starfish into the ocean.”

The old man smiled, and said, “I must ask, then, why are you throwing starfish into the ocean?”           To this, the young man replied, “The sun is up and the tide is going out. If I don’t throw them in, they’ll die.”

Upon hearing this, the elderly observer commented, “But, young man, do you not realize that there are miles and miles of beach and there are starfish all along every mile? You can’t possibly make a difference!”

The young man listened politely. Then he bent down, picked up another starfish, threw it into the back into the ocean past the breaking waves and said, “I don’t know about you, but I think it’ll make a difference for this one.”

Our Starfish Wednesday…  I had a man who was very sick on Tuesday, no malaria and I was puzzled.  I sent him off with some sort of treatment, I can’t remember what now and it doesn’t really matter, because as he started to walk away he looked weaker walking out of the tent, like he might actually fall. I summoned him back and asked Jim to review him. Something bigger was happening. He ended up getting admitted overnight and treated for Typhoid Fever. Wednesday afternoon he was upright, smiling and ready to walk out of the inpatient ward at the end of our day. YEAH! Good job Jim!  (And phew, thanks for covering for me…)

4 days earlier, we’d seen a 5 week old baby who was septic (fever) and was malnourished. I blogged about this mom who claimed “I don’t have much milk.” The ribs were lean and he looked less than his birth weight of 3 kg (6.6 lb). I put the baby to the breast and watched the baby eat. He was hungry, but face a bit vacant. Then mom stopped after about 2 minutes as if she was done. No, you are not done, I thought. Her affect was as if she could have postpartum depression. It was her first baby and she seemed a bit clueless. These people grow up with babies nursing everywhere, it’s like living in a La Leche League village! We took her to Jonathan to start an IV for medicine to cover the fever. But first I made her breast feed 10 minutes on each side. She was supposed to come back daily but did not. So for two days I’d been watching for her and asking around about a one month old baby who’d been sick. Wednesday afternoon I wandered out to the immunization tree in the camp after seeing patients.  Sweet Nurse Sharon was doing immunizations and guess who was there with the baby?  I had her follow me to the clinic. He was more lethargic, mom still complained of not having enough milk and she was supplementing with boiled water. Yes, boiled water. We discovered he still had a bit of a fever too.  This was the coolest outcome (later) and Jim and I were still talking about how amazing it was at dinner tonight.  I made her breast feed 10 minutes on each side again, and she needed coaxing to continue and to tickle feet, etc to keep the baby awake. He had a great suck and I could see him swallowing. She still claimed her milk was not much but I was able to squirt it out and it hit my arm.  “See, you have milk!”  I said. Then I mixed some F-75 formula in one of my water bottles and I started giving small amounts to the baby via a tiny medicine cup.  He was practically gulping the formula and would almost smack his tiny little lips. As he drank, about 50 ml or so, his eyes brightened and he looked around more alert. It was like watching him bloom :0)  The mom again, was unfortunately not too impressed… a bit flat still, even though I praised her and told her he was getting stronger. Again, what’s going on? Postpartum depression? Or did her thought of the bad deed her husband had done kicking the dog when she was pregnant, haunt her so that she believed the baby would die anyway?  We just couldn’t figure her out. Despite, this little “starfish” was another breakthrough that Jim and I felt could have died otherwise if she hadn’t been sought out. After feeding, I brought her to the inpatient ward to get more antibiotics for her infection. Unfortunately, today we discovered she hadn’t waited for the medicine and took off again…  uggh.  SOOOO, I hunted her down again today and repeated breast feeding lesson number 3! Only this time I asked the translator who she lived with.  Turns out she lives with her aunt who has 5 kids. So I had the translator bring the aunt to the clinic and taught her the same information and had her actually feed the baby with a bottle lid. Now the momma has accountability and is supposed to come back daily to be evaluated. Again we saw his eyes come to life. He simply wants to eat. Tonight Jim was talking about how cool it was to see that baby gulp down the formula, practically saying “feed me, feed me”.  So simple… and yet soooo complicated.

My last little starfish…  walking through the camp in the morning our hope was that I’d be able to see what kids were sick and round them up to come to the clinic. A Red Cross volunteer found us and told me about a 2 yr + 2 mo. old whose momma claimed her son hadn’t walked yet.  He’d gotten sick at age 1, was in a coma for 2 weeks and hadn’t walked since. She was told to take the toddler to the hospital in Congo if he wasn’t walking by age 2. Then the war broke out and they ended up in a refugee camp. The story was getting so complicated I cut off the intake and asked them to come to the clinic. By the time I returned to the clinic Jim was seeing the child and was told he couldn’t walk.  He said “Whoa, let start with what’s happening today… a fever, headache and diarrhea, all malaria symptoms” and all nothing I’d been told. He sent the kid off for a malaria test and when I saw this I said “Wait a minute, he came here because he’s not walking.” I was so glad Jim had started in on current symptoms before I got there because the mom wasn’t offering them to me. Her concern to me was NO walking at all. So they returned with a positive test and was started on malaria treatment.  Then I began a physical assessment. Mom had carried the toddler on her back for the past 14 months.  He’d had meningitis at age 1 and after the 2 weeks in a coma she carried him everywhere. When I had him stand in front of her, hanging on, he showed some, not much, but some leg strength. He could lift one leg and lower a bit but his feet pronated (turned in) because he’d been wrapped around his momma’s tummy. I taught her PT exercises both working on standing plus other little movements for when lying on his back. Her assignment was to do “PT” 4-5 times a day for 15 minutes and to NOT carry him all day. She is to tease/bribe him with something in front of him on a mat to make him learn to crawl toward it. I haven’t seen one toy in the camp 😦   but she’ll come up with something. Currently he can only scoot on his butt. She is to return weekly and we are confident he will progress. Maybe not perfectly but he showed potential. Another starfish! And to think I could have missed malaria because I’d only been told about the walking problem. Again, teamwork is essential!

So tonight we were very thankful. More good stuff today too but I’ve written enough and am tired. Jim and I are transitioning to thinking of how we can leave the clinic better than when we found it, as we only have 5 & 1/2 more days of work here. We want to be positive and not critical (hard at times). We have so many thoughts about how things are done here but this is not our culture and we need to work within the system, which again is challenging. Servants hearts… we have witnessed that in the staff we work with and so we have allot to learn. These staff have left their families to serve these refugees.  One of the nurse’s husband works 4 hrs away as an accountant in a bank, her 6 yr old lives with grandma somewhere else and she lives in the tiny town of Kihihi so she can work in a refugee camp.  We have no idea of how hard this would be day in and day out. Thank you Lord for the life lessons you are teaching us here, may we be better for it…

Love,

Nurse Janey

Just a cuddly cutie pie

Lone wee one along the road

Our beautiful drive thru Bwindi Impenetrable National Park

My baby in Kisoro who was severely dehydrated and loved the salty ORS

“Siffa!” I called, she turned and beamed!

Siffa’s new mom and dad on my left

Still drinking basically salt water

Dueling cameras with Jim, a great get away weekend in beautiful Uganda

#8 THE STEADFAST LOVE OF THE LORD NEVER CEASES…

January 29, 2013

As the song says…

The steadfast love of the Lord never ceases

His mercies never come to an end

They are new every morning, new every morning

Great is Thy faithfulness, oh Lord.

Great is Thy faithfulness

Yes, it was a better day today. Won’t blog about it now but just better and smiling more. Jim, on the other hand had a bad one. Guess that’s why they call it “teamwork”, where we can lift each other up and be one another’s encouragement. God is good.

Love,

Nurse Janey

ps can’t figure out why my typing is double spacing… oh well, the words are what is important

#7 TIGGER LOST HER BOUNCE TONIGHT…

January 28, 2013

Today was a hard day.  Not sure what was the real problem…  I’m not proud to say that I found myself at one time figuring out how many more days I had to do this. (cry)  That doesn’t feel good to admit, but tonight when I confessed to Jim after dinner that I was in a bit of a funk, and told him the above thought, he was wonderful.  He encouraged me that “It’s normal and not to feel bad.  We have days where we miss our family, and there are just too many sad things we are facing.  It seems to not end… In a day or two you’ll wake up and will be anxious to get back to the clinic.” Then he said “If we didn’t get to feeling this way we’d be sick ourselves”… Thank you Jim. Malaria, tropical ulcers, babies with fevers, more malaria, and then a momma with a 9 month old who I discovered was a victim of domestic violence AND the kids too (five).  That took the cake…

After dinner while taking a shower I was praying and the Lord told me

BE STILL AND KNOW THAT I AM GOD

Period. Ok.

BE STILL AND KNOW THAT I AM GOD

I need to rest in that, I am too small to understand all this pain.

When the world seems so sad, I usually have a favorite praise song (of the month) that comes to my heart to sing.  Tonight it was Brooke Fraser’s song from Hillsong United called “Soon”.  Sometimes it feels that “Soon” isn’t soon enough…

It goes like this:

Soon and very soon
My King is coming
Robed in righteousness
And crowned with love
When I see Him
I shall be made like Him
Soon and very soon

Soon and very soon
I’ll be going
To the place He has
Prepared for me
There my sin erased
My shame forgotten
Soon and very soon

I will be with the One I love
With unveiled face I’ll see Him
There my soul will be satisfied
Soon and very soon

Soon and very soon
See the procession
The angels and the elders
‘Round the throne
At His feet I’ll lay
My crowns my worship
Soon and very soon

I will be with the One I love
With unveiled face I’ll see Him
There my soul will be satisfied
Soon and very soon

Though I have not seen Him
My heart knows Him well
Jesus Christ the Lamb
The Lord of heaven

I will be with the One I love
With unveiled face I’ll see Him
There my soul will be satisfied
Soon and very soon

So I was playing the song “Soon” tonight after reading Psalm 139 where God’s word tells me in verse 23-24 “Search me, O God, and know my heart; test me and know my anxious thoughts.  See if there is any offensive way in me and lead me in the way everlasting.”  Amen.

Then this song came on next…  I especially appreciated the words “quiet my soul”…

LEAD ME TO THE CROSS      By Brooke Fraser

Savior I come, quiet my soul
Remember redemption’s hill
Where Your blood was spilled
For my ransom

Everything I once held dear
I count it all as loss

Lead me to the cross, where Your love poured out
Bring me to my knees, Lord, I lay me down
Rid me of myself, I belong to You
Oh, lead me
Lead me to the cross

You were as I, tempted and tried
You are, the word became flesh
Bore my sin and death
Now You’re risen

Everything I once held dear
I count it all as loss

Lead me to the cross where Your love poured out
Bring me to my knees, Lord, I lay me down
Rid me of myself, I belong to You
Oh, lead me
Lead me to the cross

Lead me to Your heart
To Your heart, to Your heart
Lead me to Your heart
Lead me to Your heart

Lead me to the cross where Your love poured out
Bring me to my knees, Lord, I lay me down
Rid me of myself, I belong to You
Oh, lead me
Lead me

Lead me to the cross where Your love poured out
Bring me to my knees, Lord, I lay me down
Rid me of myself, I belong to You
Oh, lead me
Lead me to the cross

THE DAY: This morning started out by Jonathan debriefing us a bit and letting us know a 6 week old died at the clinic on Saturday, about 10 minutes after she arrived. This baby was treated for malaria early January, before we came, got better then worse last week. The baby had an abscess that was progressing on her buttock but we hadn’t seen it. She’d had a bad fussy night, next day gave it “herbal” medicine, left her in the tent 2 hrs and went about doing things, came back to a cold baby struggling to breath. It was too late for her to be saved when she was brought to the clinic. A death that was so unnecessary and probably preventable. The refugees know the clinic is there and available long hours, but we are deciding to do more walking through the camp to triage and search for kids that may be sick and not being brought into us yet.

Today was a long, hot, day, with lots of patients. I was working up in the nationals clinic and a one month old refugee baby was sent to me from the camp. The new momma’s baby had a fever and was poorly nourished. She claimed her milk wasn’t very good and that she believed when she was pregnant her husband had kicked a dog and this is why her baby is sick. I found myself today asking “What do I do with this?” and many times shot up little arrow prayers to God saying “Help me Lord, this is a sick one and help me to do what is right.” THe mom had also been giving her infant herbal medicine in a spoon… a one month old with ribs showing. She just needed more breast milk. I thought at one time how it would be to be in the momma’s shoes (or no shoes) bringing my precious baby to this white lady I’d never met AND TRUSTING HER. Oh Lord, help me to do right…  this is huge responsibility and I want to do right. Jim told me that today he too found himself running through the differential diagnosis (choices of diagnosis) in his mind and contemplating the symptoms. He thought at some point that his translator must of thought he was nuts. That was a comfort for me to hear tonight when I was in my “funk”.

The contrast is huge, of skyping before dinner tonight with my darling Liam who is healthy and clean, and full of life, and he brings a green truck to the computer screen to show grandma what he has. He has no idea his grandma has been with sick/dirty kids all day who won’t have such a promising future, and who’s parents are just trying to feed and keep them well. The mom’s here don’t show allot of emotion but they DO love their children…

Saturday when we visited the Kisoro refugee camp, a 4-½ hr drive away near the Rwandan and Congo border, we were touring the camp with our colleagues and a man with a woman and baby strapped to her back tried to tell us how sick the baby was. A crowd was gathering as we tried to get their words translated. Clinic was over and they had not brought this baby in. She was about 9-10 months old, hot feverish face but cool hands and feet. Her breathing was only 24 and I expected it to be much higher with the fever. Was she shutting down? Her eyes were sunken, she was lethargic and we discovered she’d had watery diarrhea for 3 days. The mom wiped her own tears away with her wrap a few times, something I had never seen. Marilyn called ahead to the clinic and we arranged transport there to be seen first by the on-call person, and then transfer to the hospital only 8 minutes away. The referral hospital for our camp is 4 hours away so this seemed very convenient. After touring more, we stopped by the clinic again about an hour later, and found “my baby” plus 2 other sick kids waiting to be transferred. No fluids had been started. I grabbled a bottle of water out of our car, mixed it with oral rehydration salts (ORS) and began pouring it into her mouth. ORS is VERY salty and full of electrolytes.  It frankly tastes awful. If a patient likes it, you know they are VERY dehydrated. She was practically gulping the liquid life, and drank so much that she burped and vomited on me twice. Great. So I started over again, hoping some was getting absorbed and she seemed to be coming back to life a bit. Now she was more ready for the transfer…  After the vehicle left with the 3 kids, we went to the hospital for a tour with a NY doc who is serving there for a month. The last unit we saw was the pediatric admission ward where guess who was waiting in the lobby still and NOT getting more hydration?  My baby.  So I picked up the second bottle I’d given them and offered her more liquid.  She continued to drink but not as much this time. An interpreter translated for me for her momma to KEEP offering it to her. Her eyes were coming back to more life and we left. I hope she is continuing to get better even today… we have to simply let go after doing what we can.

Probably the worst case today that zapped me was a woman and her 9 month old baby. The baby had fever, cough, etc. and she (the mom) had vaginal discharge and painful urination. Turns out her husband took a second wife and the two of them were also being treated for “this problem.”  Great. I asked her if her babies right eye was always smaller than her left, was she born that way?  (thinking it looked like it could be swollen and infected but mom hadn’t complained about this at all). Yes, it was “normal” since 3 months of age. Her husband had hit her so she’d fallen on the baby and now the baby’s eye was like this, partially open. More questions. How often does your husband hit you?  About 2 times a week. What does he do? Hits me with a stick and sometimes throws me against the wall, he “takes alcohol” sometimes. Does he hit or hurt the children? Yes. Have you reported this to the police?  Yes, but they released him and he got mad at me. I fear for my life sometimes. Great…. I’m getting sadder and sadder about this and have nothing I can do. I had my interpreter counsel her that it is NEVER OK FOR A MAN TO HIT A WOMAN, AND ESPECIALLY THE CHILDREN. That is a weak man.  That she needs to go where she is safe… but she fears he’ll come after her. Yuk. More sadness in my heart. I go to Jonathan, the ugandan clinical officer and he recommends I chart on a separate paper the story she’s told me, and encourage her to take it to the police for help. I do so, including the damage to the baby in hopes the police might take it more seriously, I treat her medical issues and pray she’ll get the help she needs. There is no “battered woman’s” shelter or support here… more sadness.

So tomorrow will be another day. Another hope. Another opportunity to love on some people and try to make their life better. Many lives have been saved here, I have no doubt. Today I had a not so hopeful situation, and I had to learn that it’s not up to me, “We do the best we can” as Jim said to me tonight, “and at least we have our faith.”  Yes, at least we have our faith. Because “Soon and very soon, MY king is coming”… and

Though I have not seen Him
My heart knows Him well
Jesus Christ the Lamb
The Lord of heaven

This is my hope.

Love,

Nurse Janey

#6 ZAWADI “SIFFA” IS HOME… AND SMILING!

January 6, 2013

The highlight of my week was seeing Siffa today.  My translator Provia and I went to find her in the refugee camp first thing this morning and found her in her tent with her dad, brother and another woman and toddler.  She looked happy to see us and was definitely more comfortable.  A crowd started to gather around the tent and everyone was saying “Siffa, Siffa”.  She is kind of a celebrity now with all this attention.  Fortunately they came back with records from her hospital stay, a few labs (not enough) and an ultrasound report that showed an enlarged liver and enlarged spleen, no kidding?  But no masses.  Normal bowel loops (no air) and normal kidneys.  We STILL can’t figure out why she is so bloated, as it is not fluid from liver problems   When in the exam tent I told her via the intrerpreter that I’d sent mail to America asking for people to pray for her, and that now many people were praying for her!  Her dad smiled big and told her in thier language, then she kind of shrugged shyly and smiled again… yeah!

Jim is puzzled about her situation and thinking that since she is better we should keep her off the ARV’s she was put on for HIV. He feels she was put on them early anyway and the side effects could be resolving some now. Her dad later told me that she did not have HIV anymore and that he isn’t giving her meds anyway since they left. What? We’d been told they instructed her to go back on them. He said the hospital told him she was normal and didn’t need HIV meds now. ???  Language is just so complicated, with and without translators!  We repeated her HIV test, as well as dad’s and 2 yr old brothers. Dad and brother are negative but I had to inform him that Siffa is still positive, as we expected…  Turns out he misunderstood the ultrasound to be saying she was “ok now”.  I asked when her mother died and it was a year ago.  He explained that she was bewitched and died in the hospital with IV’s.  I told him I didn’t believe she was bewitched but that she had AIDS and he and son were fortunate not to get it. I asked if he had a spiritual belief… yes, “protestant”. I showed them my cross and said I was a believer too and believed that her momma was in heaven now and that someday they would be reunited. I asked if I could pray for them and he nodded yes. So we held hands in the center and I was able to lift them up in prayer.

Siffa looks so at peace now…

Now the parenting lecture…  I asked dad if he “takes alcohol” at night. He denied it, but I told him I know otherwise, that the Red Cross and others know he does and have told us and it is NOT good.  I pointed to Siffa and said she and her brother need a daddy to take good care of them, their momma is gone now and he is all they have… and that the bible tells us that “Children are a gift from the Lord”, and when he chose to have children he took on the responsibility to take good care of them. He seemed to listed to my words (via the interpreter) and I praised him for how he had been taking better care of her the last few days by washing her clothes, etc. Smile again. Siffa patiently waited while all this adult conversation was taking place. I promised to find them later and let them know the doctors decision on her medications.

At the end of our day my interpreter and I found Siffa once again in her tent. She came out in yet another cleaner top! Lots of children and adults gathered around. Again, she looked like a celebrity in the camp. She smiled at the attention and looks SO much more comfortable now, it is simply the best.  We had brought her a bag of 20 “plumpy nut” packets from WFP (World Food Program). I almost got mauled (just kidding, but close) when I brought them to the camp, as they are in high demand and loved like candy. Each packet is about 500 calories and full of good stuff (kind of a peanut butter squeezie) to give good nutrition. When leaving I hugged Siffa and kissed her on the forehead, and she smiled again and kept longer eye contact. The mom who seems to be helping them out said loudly “Oh Siffa, you have a new mommy, this muzungo loves you!” I didn’t know what she’d said but Siffa smiled big and the crowd joined in kind of cheering. Provia translated for me and I was SO VERY HAPPY!  I waved good bye and said we’d see her again on Monday…

As Provia and I walked home to the upper camp, we discussed Siffa’s reaction. Provia beamed and said “She is SO happy, she is improving!”. I told her she feels loved now and is enjoying all the attention, and that when she is known as “the girl with HIV” in the camp, she becomes kind of an outcast or like a leper. Now everyone seems to be enjoying her and she is getting more attention than anyone! Her medical situation is still uncertain, and most likely not hopeful, but she feels loved.

Touch, she needed touch…

It was a great ending to the week and I say thank you Jesus, for answered prayer.

Love,

Nurse Janey

P.S. Many of you know that on January 6^th a baby girl was born to one of my prior drivers for a Uganda trip.  I received an email from Peter saying his second baby girl was born and her name is “Janey Pineo”!  … Not Pinneo, but Pineo.  He was asking for my prayers because she was in the hospital after delivery and still sick. I later got news she and momma went home. Today I received an email photo of my beautiful namesake, more good news!  TGIF

P.S.S. We head out on a weekend driving trip to Kisoro Camp where our 2 colleagues are working at a camp with about 6000 Congolese who have fled the M23 rebels.  We look forward to seeing them and also to cool off a bit as it is in the mountains. Nurse Marilyn has been going to bed in fleece with a hot water bottle, when I have needed 2 showers to cool down. We hope to travel home Sunday via Bwindi National Park where the gorillas are. Jim and I are happy to see new scenery and maybe a few monkeys :0)

Remember I said you put on some cloth and voila!  you are dressed?

Of course they have big smiles until I point the camera at them!

Sweet Siffa is home…  look how clean she is :0)

Jim checks Siffa out and then we review her medical records

 My little visitors at the tent clinic door, they ventured inside to get closer at the mzungo

Baby Janey Pineo, born January 6, 2013.  So fun!

#5 FAMILY… HAVE I MENTIONED HOW MUCH I LOVE MY FAMILY???

January 25, 2013

A huge difference from this mission trip comparing it to my first trip to Uganda in 2005, is that we were allowed about a 15 min phone call once a week, and there was no WiFI.  I had no laptop, computers were archaic, and transmission VERY slow.  I remember typing my journal and being almost done, only to find the email crash and disappear…

This trip and the last one, I’ve had a laptop (as Jeff says, I’m having an affair with MAC, whom I love), and we have access to a WiFi stick connecting us actually to a phone line.  I have no clue how it, “the stick” works, all I care is I get to see my families faces and hear their voices almost daily.  Jeff too, is away from home, so seeing each other is awesome. Sometimes he sounds like the chipmunks cartoon, but makes me smile.  I was actually supposed to be with him on his trip, but when the offer came to go on a team to Uganda, it tugged my heart and he knew I was lost and said “Go”…  So now I can be useful here, and he useful there.  All is good :0)  I’m so proud of you honey, of just “YOU” and the great job you are doing.  You are my buddy…

Casey is doing a one month “sub-i” or internship in Denver for this month, and I am so proud of the hard work you are doing Casey.  You are so very dedicated to doing well AND to being a good husband and daddy. Chelsea and Liam joined him in Denver and they have been staying at our WONDERFUL friends, Scott and Diann’s in Golden.  Then the extra bonus and ANOTHER wonderful hospitable thing from Scott and Diann, Luke joined them!  You are amazing Scott and Diann, welcoming them all into your empty nest, and I know they have loved being with you and your grown family that is nearby. Your house will be so quite when they leave  or 🙂 … could be both!  Luke is on route back to Buena Vista where he guided white water rafting the last two summers, so he took a detour in plans and lived with them in the basement for about a month to help with Liam and get special “Uncle Lukey” time.  He and Liam are absolutely “tight” right now and I warned Chelsea he may steal him when they try to leave.  If you are a grandma, you can imagine how it warms your heart to see your family living together like this…  Casey had a good month in the NICU, neonatal intensive care unit, but is ready to head back to Loma Linda for the end of his fourth year in medical school.

***A side note: All these details in my blog may not be important to many of you reading, and make them quite long, so sorry… but they are for ME, because it’s all about me, right?  Just teasing…  My journals serve as my memory, and I have a book of them at home that I occasionally go back and read through.  They transport me in time to the place I was in my heart.  It is invaluable, and I actually hope someday my grandkids (note plural… I’m hopeful) will want to read them and learn about God’s hand on their grandma’s life, and Grampy’s too of course, especially when we are gone.  So, you won’t offend me at all in not reading any of my blogs, they are LONG and I’ve never been known for being short winded, right?  I’m a detail kind of gal…

Sweet Liam… how fun it was to see your cute little white body in the bathtub, and cute buns too of course!  You are only 20 months old and talking soooo much, and with such expression too! Then I got to see you playing play-dough on Scott and Diann’s table with their cute granddaughter Raimee… reading on Lukey’s lap and the playing with daddy on his day off.  I got to see you playing in your first snow and trying to climb up a tiny icy hill, so determined… oh how I love you so very much and when I see the toddlers here I think of you ALL THE TIME… and of how clean your mommy is able to keep you :0)  She is an awesome mommy!  I have fun seeing your sweet face in my computer photos.

Chelsea and Luke, I tried to take a photo of the bell of my baby blue stethoscope today, where you both had it monogrammed for me saying “J. Pinneo, RN  Matt. 13:9”. I couldn’t get the lighting right   I think of you both whenever I glance at the words, and then chuckle at the scripture you chose Luke, Jesus’ words of “He who has ears, let him hear”  Perfect!

Our fine abode, “Hotel Suba” has been wonderful.  We were warned upon arrival and by an earlier volunteer, that we would NOT have flush toilets and would need to venture out for all meals.  Suba had vacancies and we are so fortunate to be here.  Our rooms are small but adequate, and they have flushing toilets which is simply the best!  The other is good for stronger thighs, but I’d take more flab anyday over no toilet :0)  We have a pretty complete menu of choices but tend to order rice and beans, a small vegie pizza, a WELL done burger, spagetti bolognese and curry chicken.  The french fries are wonderful! AND safe… and we’ve learned to order a “boiled” diced veggie bowl for the side, as we are having NO fresh veggies.  I really do so miss a salad, but the risk is too great.  I was rinsing my toothbrush with tap water and THEN bottled water before I had my sick night.  Jim said he NEVER lets tap water touch his toothbrush, so I have changed my technique.  It’s easy to get lax over time…

We are woken with coffee at around 6:30, instant Nescafe which isn’t bad… BUT I brought some VIA’s from starbucks and we’ve been enjoying those.  I’d say I’m the “social” director of our team, with starbucks via’s, dried apricots, trail mix with M&M’s, face wipes, etc.  And Jim is the “medical” director with a bag full of books. It’s a great combo :0)

Off to the clinic and hope to see Zawadi “Siffa” today…

Love, Nurse Janey

My roomate… comes and goes

Starbucks…..

Dehydration prevention corner in my room :0)

#4 Malaria, Malaria, And More Malaria…

January 23, 2013

Sunday was a day of rest.  As we enjoyed it, God’s design for it becomes more evident because we were tired.  Not from overworking at all, but the fatigue of learning new routines and cultural norms, seeing this refugee / poor population, and the heat, muggy heat.  It is a zapper.

It is a blessing to be working with a fellow Christian (Jim is Catholic), for we share the same dependence on and love for Jesus, and our conversations have a different depth to them.  MTI is a Christian organization, but it is not a requirement to be a believer, but just a respecter of the mission statement: “To demonstrate the love of Christ to those affected by disaster, conflict and poverty.” I have been on teams that are mixed in faith foundations, and that is rich too. We tend to attract VERY GOOD VOLUNTEERS and for that I am thankful.  Jim likes to go to church too, so yesterday, Sunday, we walked to the Catholic church at 8am and found one person waiting, also a visitor.  So we three walked about 1/2 mile to the Anglican church and found the parishioners dwindling in from 8-8:30.  Once the service got going, the preaching was passionate and the singing as always, had soul.  It was lovely. I am always so blessed to see the children joining in and worshiping with their parents.  Toddlers stay quietly by there parents side, because it’s just what they do.  For at least 1-1/2hrs!  The remainder of the day was restful (and kind of lazy) so by Monday am we were raring to go…

I was woken by a text beep at 5:15 am from clinical officer Jonathan.  He had been checking on Zawadi in the ward and felt she had worsened.  (by the way, we discovered her first name is actually Siffa).  I feel bad we’ve been calling her Zawadi, but the staff tells us “it’s ok”.  That’s like me being new at a clinic and everyone calling me “Pinneo”.  Seems rude to me thankfully not here.  So we are now calling her Siffa.  Anyway, her spleen was now larger (it was already huge) and more tender, she’d had a bloody nose that had now stopped (this can be a caused by poor clotting due to liver enlargement), no fever now but worse “DIB” on the text.  “DIB?” I thought.  I called Jonathan who had been with her for 40 minutes now.  She was finally urinating ok and was a bit better.  They LOVE Lasix IV in Africa and use it liberally when there is poor urine output.  We, on the other hand, believe in rehydration fluids to perfuse the kidneys and not further dry out the blood volume with a diuretic.  When we arrived at 8:30 her pulse was now 104 (down from 160), no fever and respirations 24 (had been 40). The fluids we had ordered had worked and they had thankfully stopped giving lasix.  She looked better but her pain was definitely worse, tender to palpation and we needed to work harder on getting her to a hospital.  Fortunately, Jonathan had stopped the ARV’s for her HIV.  This is unfortunate, BUT the side effects were so severe they needed to be stopped, Jim agreed and was planning on doing the same this am.  I am clueless in this area and thankful that Jim worked with HIV/AIDS for 5 yrs. MB, your knowledge would be useful here :0)

I sat next to her on the bed, kissed her forehead and gave her some things from the little bag I’d put together.  A few bars of soap (I instructed her dad to go and wash her clothes for the journey, but don’t think he ever did ), gave her a banana (she slowly ate ½ half of it and quietly handed the remainder to her dirty but cute toddler brother… so so sweet), I then gave her a protein bar and water bottle to get more calories in her.  As she ate, I took one of my face wipes and gently washed her face and removed a little old blood, then washed her chest and arms.  She did not resist but not a single smile.  What is she thinking I wonder?  Her father smiled at me and I was hoping she liked what I was doing.  I do think she trusts us though, and feels loved.  Touch… she needs touch…

The transfer to the hospital had to wait until afternoon due to the ambulance needing to drive someone to a meeting 30 min away first.  We will follow up on this later, for we felt her transfer should have taken priority and we should have asked to discuss the prioritizing.  We are learning, and don’t want to be “the ugly Americans” who insist on their way.  Jim & I have the utmost respect for all the hard work being done here, they are servants to these people and without complaint.  I asked my translator Joshua today if he liked his work here. He is a lab tech and rotates in as translator with volunteers.  He smiled big and said “I love my work”.  So wonderful to hear and also very evident in how he communicates with the patients.

MALARIA… not sure what happened over the weekend, but we saw SO MANY malaria cases today.  40? Or more?  Haven’t heard the final count yet.  I had one momma with a 2 & 4 yr old who came from Congo just one day ago.  The kids had been sick with fever for a week and they both had very large Malaria parasite counts on their blood slides, the largest I’d ever seen.  The 2 yr old had to be admitted for IV quinine since she was somewhat lethargic and couldn’t take the oral meds (remember, kids under 5 die often from Malaria). Later my translator and I were walking the 100 yd path toward the nationals clinic and came across the 4 yr old going the opposite direction to the camp.  Mind you, she had only lived there 1 day but her momma sent her to go get her bag with water in it from her campsite and she obediently was on her way.  A four year old!  And not only that but a four year old with Malaria that we discovered hadn’t even started her meds hours later!  We turned her around and had her walk with us back to the inpatient ward.  Her momma couldn’t have left the 2 yr old so this was her only choice.  She hadn’t started her malaria meds because they had no water.  I brought out one of my bottles and gave her the first doses of her meds and the extra water… thank you Lord for having our paths cross at just the right time.

Malaria parasite counts are done on a blood drop slide and we’ve seen anything from 20 mps-3000 mps counts on the lab result sheet.  The 2 yr old in the above paragraph had the 3,000 count and was getting IV quinine.  Late afternoon I had a 10 kg (22lb) 1 yr. old child with a count of 8,000!!!  She appeared ok so Jonathan said to have her wait, he wanted us to see more of the big crowd that had gathered, then he would start her IV and the Quinine.  We were cranking through the patients as fast as we could.  Nearing the end of the crowd I had Joshua look for her.  She was no-where to be found   Where would this momma have gone?  No one knew where she was and I felt so guilty feeling, that we had made her wait.  I was praying she would show up but by the time we left she hadn’t. My hope is that she will be in the in-patient ward when we arrive in the morning…

***I should note that we have a stash of rehydration salts, antibiotics, and malarial treatment meds for us with us and in our hotel room, should either of us fall sick in the night.  AND we have a pact to wake each other up if we get sick. I have yet to get a single mosquito bite :0)…. yeah!  I few nights ago I had an upset stomach, both ends (sorry, TMI) threw up 3 times and felt like a charm!  I called Jim just as an FYI because we had promised, in case I got sicker in the night.  He didn’t mind (it was late), was very appreciative, concerned and thankful to know, a great teammate.

Wednesday…  We are back at the hotel now after a shorter but HOT day in the clinic.  The patients were fewer and much less malaria.  Some severe cases though, 3 deliveries before we left with one more on the way.  I missed the first one this am by 2 minutes!!!!  Bummer. It was mom’s 6^th and she wanted to talk to someone about family planning.  What a concept?  They have the shots available here for much longer protection which is awesome.

We finally got news today on Zawadi (Siffa), that the hospital refused to admit her, UNBELIEVABLE, and they said her tests were normal and they put her back on her ARV’s (anti HIV drugs).  She apparently in on the veranda of the hospital with her dad and brother, no mats I believe, and not sure frankly how they are making it.  At some point we will have to pick her up I guess.  Still figuring out the system but the staff know it and are aware.  We have asked Bruce and Julie (a wonderful duo married nurse team from Oregon that worked with MTI in a few of the camps) to stop by the hospital and check on her.  Hopefully they will find her   since we’d told them she was inpatient.  It is so frustrating trying to help in this type of situation, and we have to back off on some of it.  Her belly scan showed air and not fluid, and apparently her liver tests and kidney tests were normal… HARD to believe, especially the liver.  I will keep you posted when we hear more or she returns.

Yesterday I had a toddler and 7-½ month old with severe malaria, needing an IV for quinine infusion over 4 hrs.  Jonathan, the clinical officer, is the main IV guy on little ones and he tried about 6 times to get a line in on the baby.  He screamed and screamed as Jonathan went from one spot to another, failing. He felt so bad and kept aplogizing to me but I told him we have a hard time with IV’s at times too, it’s “ok”.  The mom was quiet and stoic, helped to hold the baby down and occasional bent down to nurse between attempts.  It brought back memories of sweet Liam’s 10 days of IV’s when he was 3 weeks old.  Chelsea couldn’t even be in the room at times.  He had MANY IV’s but not such a hard time starting them on a chubby, well hydrated WHITE baby with BLUE veins.  Loma Linda had a transducer that when held under the palm, it illuminated the vasculature.  I thought as Jonathan was working so hard… “I wonder if that would work on beautiful black skin?”  I need to check on this when home.  They are probably so cost prohibitive, BUT these poor babies are hard to stick and it would be an amazing tool here.  He finally had to give the med IM (via muscle) which is VERY painful and has bad side effects if done poorly.  It was so hard to watch.  This malaria parasite simply has to be stopped…

Yesterday one of the non-medical staff (27) had a question for me as we were waiting to load up and return home.  Earlier in the day he’d brought one of the toddlers to me with a very concerned momma, he too was concerned and had examined the child.  She showed me the boys scrotum which had one swollen side, non tender, non warm, testicles both down, and she reported it fluctuates from larger to smaller on the one side only.  This is called a hydrocele, I explained, where fluid accumulates off and on and is often surgically repaired (in the states at least) but not here in this situation.  The young staff member was now concerned about himself.  He later reported to me that when he was in “Senior 1” (about 14-15 yrs old) he had pain in the scrotum at school and couldn’t walk so was taken to the hospital. They did surgery and he doesn’t know what they did to him.  His concern?  Will he be able to have children?  If he marries he will need to be tested because if he can’t produce, “I’ll be of no use”.  Unbelievable.  I told him “What about marry for love, you can always adopt?”  He said “Oh, that is very expensive”, etc.  So the anatomy lesson began and I drew him his anatomy and how the testicles SHOULD be down but that they can travel up and down but should not stay up or become painful or get twisted because they can die (testicular torsion).  I assured him that even with one testicle a man is very fertile.  Oh my God, I was giggling inside thinking I can’t believe I’m having this conversation BUT was not wanting him embarrassed with me or to be “fearing” as they say here.  He said with a concerned face “Maybe tomorrow you can check me and see if I’m ok?”  I calmly said, “You know that would probably be better for Jim or Jonathan to do and they can assure you that you are fine…  phew.  Good answer Jeff?  Too funny!  (not his concern but the scenario) I also told him how he can check himself to see if he still has “two”… (smile inside again).  So today when we arrived I privately asked him if he had checked himself and if so was he ok?  He said with a smile, “Yes, there are two”…  problem solved.  YEAH!

Soloing kids… both yesterday and today I had young boys come with fever, etc and get diagnosed with Malaria.  So what do you do when they don’t have a momma or daddy to give the meds to?  Or the bigger 10 yr old brother comes with the little 6 yr old sibling? You give it to them, to the 7 or 8 or 10 yr old.  AND they will take it I am told.  Momma is in the field, or taking care of other children, or, or, or…  it is what we have and somehow it is working.  We American’s on the other hand, can’t send a tylenol with our kid to school in their backpack, even at high school, without a doctors note… BUT they can go get an abortion without parental consent at 14, I believe  😦   Who’s really messed up?

I had a mom who delivered a baby 2 weeks ago and presented at the clinic with mastitis (breast infection).  She was in so much pain, one breast was hard and warm with reddened areas, smaller and very painful, the other was larger and long and producing all the milk for the baby.  They believe you don’t nurse the baby on an infected or clogged side, exact opposite of what you are supposed to do for mastitis, so it was getting worse. It was a great teaching opportunity with the clinical officer.  Today I had the fear that in the moment of teaching WHAT to do with feeding, warm packs, etc. That I might have forgotten to write for her antibiotics… I hope to God I did not : /

Today I saw a 15 month old malnourished boy that Jim had seen late yesterday in the refugee camp clinic.  Turns out the boy did NOT have malaria but was asked to be brought back today since he was so tiny and had other problems.  The dad was about 23 or so and his wife had been killed in the ethnic cleansing attacks last November.  He had just arrived 2 days ago and was alone with this tiny toddler.  Unbelievable.  Dad’s affect was pretty flat and the child still had a fever but sat calmly on dad’s lap and did not fuss at the Muzungo checking him out.  Antibiotics were started as well as many other things, and F-75, an amazing power mixed into clean water that serves as a very hi caloric milk substitute for these babies. The World Food Organization supplies this.  The boy was adorable but not really playful, AND way too tiny by the MUAC measurement of his upper arm.  He was in the “red” zone, which indicates severe malnutrition.  At the end of the day I walked over to the Red Cross tent to report this twosome and asked that someone check on them frequently. Our MTI nurse “jane” was concerned that dad would not do well without the momma.  I, on the other hand, told her that the good thing is that he showed up with him on the first day.  That’s a good start.  Redcross already had their eye on him and would check frequently.  Apparently he already had friends in the camp he knew in Congo. Sad but true, and could be good support.  As they say… “It takes a village”, certainly true here for sure.

I am so grateful for being back “in the field”… literally and figuratively.  I have felt alive taking vitals again, assessing children (and even adults), and in using play therapy with my stethoscope or pen light to win over a small child before I examine them.  Nursing “stuff” is coming back to me like riding a bike… I feel alive and energized and thank God for the skills I have been blessed with and the opportunity to use them for such needy people.  It is truly a privilege being here.  As usual, you take away more than you left.  I am a bit saddened to not feel so shocked anymore though, at the shreds of filthy clothing the woman have to dress their children in, and the suffering in the lives they lead.  Now I look at them and move aside the dirty cloth and think “Wow, it’s all they have”… but I am not shocked anymore.  Maybe that’s ok.  Maybe not?  I used to want to come home and somehow ship a peddle sewing machine to the camp for mending. Hasn’t even crossed my mind this trip. Why is that? I don’t see shame in their faces either, they are just taking care of their children as best they can, making it through each day.  To clothe a child here means to put “some” cloth on them, no matter how torn, and they are dressed.  Then the little herd of children runs off to who knows where and passes the time in the dirt, grass, sticks… you rarely see a child cry or complain.  A 3 yr old swallows half a Bactrim pill without a wince, because it was put in their mouth and a splash of water followed.  Amazing. No bargaining or whining or bribing.  The staff here are either Catholic or Christian it seems, and they do not question God with what they are seeing.  It is just part of life and part of fallen man that has brought most of this on.  They show compassion to all and continue on working long hours without a complaint… I don’t see them eating during the day, unless we’ve shared treats or extra bananas with them.  It’s what they do and I am very impressed by their hearts and hard work.  They appreciate us and we appreciate them… it’s a wonderful team and this makes me smile.

Lastly, a staff member here is under medical care and I have been worried and trying to help with some intervention.  It has been very helpful I believe, but today I got concerned and expressed it to the staff’s loved one (that I know from years past) and they said to me in an email,

“Janey, Don’t worry, God is in control!  He is slowly stabilizing…(more context)

Please, don’t be worried because God is in control.”

Thank you:)

Faith… I want to have my faith be such that I can do what I CAN do, but give up the worry and simply trust.  I have witnessed this, and this, I believe, will be one of my biggest gifts from this trip.

~Love ~

Nurse Janey

After washing Zawadi down a bit, before going to the hospital

Infant/small toddler scale

Young boy (8?) who brought himself to clinic for possible Malaria,

he was right and walked away with meds.

Siffa in the ambulance with dad and brother

“Hope is on the way”

Painful breast infection, unbelievable

One of my favorite things….

Jim found a villager-fellow RedSox fan :0)

Awesome logo for UNHCR: United Nations High Commission of Refugees

Beautiful malnourished 15 month old who’s momma was killed

#3 Zawadi… Sadness… Heaven Would Be Better

January 20, 2013

Today is Saturday so we worked a half day with the nationals.  I’m really glad we did, because Jim was able to do good follow up with the 13 yr old who is HIV+.  Her name is Zawadi, or at least that’s what we thought and have been calling her.  Apparently it’s her last name but I’ll use it for now.  We gain more information daily, it turns out she does have a dad in the camp and he’s come 2 days now with her and was not drunk.  He’s of course, also HIV+ and on ARV’s also and has taken a new wife. Zawadi has many medicines to manage and we had been told she lives alone in the camp and others look out for her (not her dad).

 

Zawadi…  she needs a momma, OR an attentive daddy

On Thursday Zawadi came into the clinic, was tachypneic (high respiratory rate) and her belly was so big she appeared to have ascites (fluid in belly) from liver failure.  This is most likely why she was breathing hard, kind of like a full term pregnancy, and it was difficult for her to lie on the exam table.  Jim did a thorough assessment and was very tender with her. He found both her liver and spleen to be enlarged, eyes NOT jaundiced, some anemia but most likely she was having bad side effects of the HIV meds which were now damaging her liver.  Her jumper dress was filthy, heavy with soil and hard to even handle. I wanted to take it with me and launder it, something we cannot do as it could cause problems in the camp with others.  Her affect was flat.  Sad, sad, sad…  Dr. Isaac came per our request, to also assess her and fill in the gaps of what had already been done for her. Turns out she’s already had 3 weeks in the hospital but it’s not apparent to us what was done for her.  He pierced a needle into her belly to aspirate fluid and only got air.  She was stoic and tears flowed gently down her cheeks. They do not prep patients here, it is normal to just have “stuff” done to you without explanation, it is not expected. Touch, I thought, “She needs touch…”  I removed my gloves as the latex barrier puts up a wall and does not feel loving.  Then I touched the tears on her cheeks and felt a little fear myself…  but she needs touch.

We are not supposed to give gifts of any sort in the refugee camp, for it can cause fighting and demands from others in the camp.  But I couldn’t help giving her a bag of 5 protein bars to take with her.  I opened a yogurt coated protein bar and had her take a bite.  No smile but she timidly ate.  She later was up at the nationals clinic receiving medication distribution and I saw her walking behind our vehicle to go back to the camp.  I called to her and motioned her to come my way.  I gave her a ½ full water bottle and got a little smile, very little.  Then as she walked away toward the path I called out to her again and smiled and waved.  Another little half smile.  This, I feel, is our goal now… to make her smile.  Her life is so sad and hopeless, and earlier when she’d been lying on the table I turned to Jim and said “This is when heaven would be better.”  He agreed.

I love working with Jim.  He is a gentle man, 70 yrs old and very experienced and non reactive.  He is very logical and if I’m a little off base, he speaks up and gently suggests another way.  Thanks Jim.  We are learning from each other and make a great team.  Since our exam “rooms” are only a tent drape apart from each other, we hear our conversations with the translators and occasionally say across the drape “I didn’t know that”.  It takes a team for sure, and we too are learning from the nationals.  They do this care day in and day out, and see the same things over and over again.

Yesterday nearing the end of the day 4-5 men came running to the clinic with a passed out man.  I called to Jonathan, the clinical officer, saying “a man is coming that looks like he has cerebral malaria.”  He looked like the soldier we helped in Northern Uganda years ago.  Silly me, turns out he was drunk, VERY drunk.  They hustled to get an IV in, pushed high dose dextrose and fluids and apparently he came to hours into the evening when we were gone.  Jim has seen this lots in the ER, but me?  Not too much of this in peds :0)  I tried to tell his friends that he could have died and how dangerous it is for them to drink this much.  Home-made hooch it was, very strong and toxic. They said he hadn’t eaten in 2 days and this is why he was so drunk.  Sure.

Drunk man -vs- Cerebral malaria?

Friday I was seeing refugee patients while Jim escorted Zawadi to the level 4 clinic in the Kihihi area.  This is the best referral option we have other than a 4+ hr drive to the nearest hospital. It is also where she has to go monthly to evaluate her response to the HIV meds. They were familiar with Zawadi and the charge nurse tried to tell Jim that her liver was NOT enlarged.  He is a very tactful man and not argumentative, BUT he was not going to agree with that. They conceded and the meds were changed to a different combo.  Jim feels she really needs a bigger facility and more in-depth testing.  We are not confident of her prognosis but she is uncomfortable and something more complicated is going on.  Today she arrived with a fever, higher respiratory rate & heart rate and just looked plain worse. We brought a pulse oximeter (one we will leave with them) and measured her oxygenation which was good. We are so limited on what tests can be done for her here.  Jim ordered IV fluids and antibiotics for her fever.  A plan is being set for her to be transferred to the Mbarara hospital ASAP. I was able to sit with her for a few minutes before leaving, hold her hand and pray for her.  Touch, she needs touch…

Jim and I discuss the days work – often over a cold beer – when we arrive home to our little hotel.  We are sweaty and hot having worked in a stuffy tent of about 85 degrees. I feel like a wimpy American.  Our work feels good and purposeful, but not the volume I have been used to on my other trips.  It’s hard not to grade yourself in terms of number of patients seen.  Tonight we agreed that this trip seems to be more about teaching.  Some of the staff are very young and they have them rotate through as translators, working with the MTI volunteers.  These nurses, roughly LPN training level, are seeing patients themselves and prescribing when we aren’t there.  The volume is just too great for one doctor or clinical officer to do (Uganda has one doctor per 60,000 people).

Yesterday I arrived at the camp “clinic” tent and a nurse was seeing a teenage patient and had written prescriptions.  I asked them about the patient and they said he had a cough.  They were dispensing amoxacillin for him and so I started our spiel about how you don’t give antibiotics for just a cough alone, there needs to be fever or pneumonia or something more, Jim re-enforced this.  I listened to his “clear” lungs and started to chart on the paper and saw the word “wound” also written. “Oh” I said, “I am so sorry, I thought you were giving amoxacillin for a cough.  Where is his wound?”  One nurse said “I don’t know, Provia was seeing him”, then Provia said “I didn’t see.”  I asked the young boy of about 12 where his wound was.  He pulled up his shorts and showed me what looked like a bullet wound in his left thigh, red, swollen and draining.  Turns out it had been a boil when in Congo and a “doctor” (?) had opened and drained it 2 months ago.  He has been in the camp since and this was the first time he’d come for help.  These people are stoic and live with allot of discomforts as simply a way of life.  The nurses reacted with “Ooh, that needs to be dressed”.  Another teaching opportunity…  you never prescribe a drug without first seeing what it is you are prescribing it for.  Again, I think this is common practice by the nurses (not by the docs) in order to help see lots of patients in a day.  One nurse told me they don’t listen to lungs with a stethoscope if there is a doctor around “out of respect”.  I encouraged her that it would be good to do so if she thinks someone has pneumonia and they are writing for drugs.  The doctor is 100 yds. away and he would want her to examine the patient.  Jim had an idea at dinner of having his nurse translator see the patient and he do the observing and coaching.  I thought it was a great idea and will do the same.

Teaching, that is what we are here for… and Zawadi.

~ Love ~

Nurse Janey

P.S. Simple pleasures in Uganda… watching staff enjoy trail mix with you, picking up one morsel of nut, raisin or M&M and savoring each single piece.  AND of course

… a flushing toilet  :0)

Malnourished 1yr old

 

Wonderful, hardworking nursing staff

Unexamined wound

Just a cutie pie with a hand made jute ball

Sad Zawadi…

Machete wound stitching, great job Dr. Isaac!

Community education

Peek a boo!   I love you!

#2 First clinic day in the refugee camp….

January 16, 2013

***My apologies for such delayed publishing, I am having technical difficulties and this was ready 24 hrs ago… I know, what a shock!  Luke is my personal assistant and is helping me, if I can ever get the email with photos off to him!

Before I begin, please note that this blog is for family and friends, your friends too.  But please do not post on any website for it can be a security risk for us and is not wise at this time.  (i.e. Facebook, etc.)  Thank you for considering our safety.

First day in the field…  it was a wonderful day.  Jim (PA) and I were able to see patients in the refugee camp, FINALLY.  We left our hotel around 8am and drove through beautiful villages on a red dirt road for about 25 minutes.  I am saddened a bit by my “numbness” to the filthy but lovely little “buddha babies” we see along the road.  It is a familiar scene but both Jim and I say that the more you see, the less shocked you are. I think this is a natural progression of response, so don’t think I need to worry about myself, or do I? Now I immediately look past the dirt/food stained, pee’d on, multi-torn, missing button, sewn shut zippers, and see a beautifully skinned beaming child waving or running at the car with a huge belly.  “Mzungu Mzungu” they yell, which means “white man” in Swahili…  a lovely way to start the day…

Yesterday I did not journal, for it was an introduction day for MTI’s Dr. Isaac to take us around the refugee camp and meet various leaders of the 5 NGOS that are working together under UNHCR (United Nations High Commission for Refugees) and there simply wasn’t any action to report.  The African way is very formal with introductions, greetings, and appreciations for us coming NOT being quick.  Mind you, had there been a line of 100 or so refugees needing to be seen, we would have passed over the formalities and gotten to work.

It turned out to be a good day for us to familiarize ourselves with the systems, available medications, see the maternity ward (ante-natal unit, delivery room, lab and post-partum all in one small building).  We were feeling guilty though that our work had not begun, wondering if our colleges Marilyn and Mike (nurses from Toronto and Anchorage, respectively) were getting slammed.  Turns out they were NOT slammed and their day was manageable.  The Kisoro camp is positioned further south near the corner of Congo and Rwanda in the mountains.  At Kisoro there are about 4,700 refugees.  Last week there were 80-100 arriving daily to the transition center, many not having eaten after 5 days in transit. They have been fleeing from M23 rebels killing across the border. They currently are at a cease fire and so the influx has decreased to 30-50 daily.  I had never seen a “transition” refugee camp before this trip.  It’s soul purpose is to be positioned close to the border where military receive them along with UNHCR, and bring them to the camps for stabilization before transporting to a permanent refugee settlement. Yesterday alone the UN transported about 800 refugees for relocation to permanent camps, 90 people per bus load. In the Matanda camp where Jim and I are, admissions are slowing down.  The Congolese here are about 4 hours north of Kisoro and they are fleeing from tribal ethnic cleansing which has now slowed down.  Our camp had over 4000 refugees in fall and now has about 600. Note: we feel VERY safe.  There is military presence in the camp to keep the refugees peaceful and military on the border also. Nationals and Congolese refugees are kept separate for the same reason… peace.  We can see Congo from where we are but have no desire to visit. Good idea honey?  Apparently a couple of volunteers in the past journeyed across the border but if you do, MTI and Ugandan government have no authority there.  Jim and I are quite content in our safe sleepy little town of Kihihi.

We were able to meet all the MTI staff for both the refugee camp and the clinic staff that serve the nationals (again MTI) only a short trail away from the refugee camp border. We are very impressed with the organization of the clinics, the med room, etc.  There is room for improvement though and this is where MTI volunteers coming monthly can help improve the systems. Already great exchange of information between staff and ourselves is taking place.  Jim and I were talking at dinner and reflecting how we too learned from them today.  Our assigned translators are a nurse and lab technician.  They each have worked with MTI for only 4 months and are new grads from their programs. They already have allot of knowledge and help us in sorting out the symptoms, cultural norms, etc.  But exchange of information is one of the key important roles of Medical Teams International volunteers.  They ARE giving good care, by African standards, but with monthly volunteers coming they learn better diagnostic skills, and treatments working side by side. Dr. Isaac (Ugandan MTI staff) said their treatment of patients has a higher standard when we show up.  Yahoo!

Highlights from the last two days:

**Upon arriving to the Nationals Clinic, a mini truck pulls up with a young boy 12-14 who is a field worker.  He was found collapsed in the field and was now laying across a mans body in the bed-truck, his eyes did open but he was not talking.  Dr. Isaac asked questions of the driver and then had him taken to an exam “room” in a tent.  While Jim was watching, he kicked into ER mode and reached for a wrist to check his pulse.  Coloring is of course harder to assess immediately with his dark skin. We walked away from the truck with Isaac and he then warned Jim he should not have touched the young boys skin without a glove, that as a field worker he could have Ebola…  oops, gotta retrain our thinking.  About 4 months ago this district saw about 4 cases of Ebola. Glove, gloves, gloves…  Turns out the young boy had been working hard without having breakfast and had a hypoglycemic reaction.  Thank God.

**Walking through the camp yesterday the flock of children kept growing and growing.  At one time Dr. Isaac told the children in a nice way to sort of back off and to please not crowd.  I told him “No, it is fine… this is what I LOVE”… being a pied-piper is simply wonderful!  :0)

**Upon arrival today there was a young woman in labor with her first baby.  She had lost some blood and so Isaac was called to assess.  He started the IV to give her fluids and instructed the midwife when she “should” deliver by. We spent some time with her watching the exam and I TRIED to coach her on breathing methods to help bare through the contractions. Not too successful but she did take my hand at one time.  I also got to place my hand on her beautiful tummy and pray for her and the baby.  The midwife had been busy all yesterday with a room FULL of pregnant woman to see for antenatal clinic, and then at midnight this gal arrives with contractions. So she had been up all night and looked very tired.  The midwife is 8 months pregnant with a VERY TINY tummy. Her colleague midwife is out on maternity leave. I am concerned she overworks and this is why her baby is so small.  Not too unusual in Uganda though, working hard, long hours… at least for the woman. The good news?  A beautiful baby boy entered the world by late afternoon and both he and momma did well.  I was disappointed not to get called for the delivery as I had requested.  I need to be clearer next time! I am ITCHING to be in on a delivery again.  Jim, who is a PA in the ER tells me deliveries are not his thing.  He is happy that at home they are sent to Labor and Delivery and has told me it could be “my thing” should we come across a delivery… kind of a scary thought since it’s been years for me. I’m sure the 2 of us could figure it out :0)

**Older man with a machete wound: Jim gets called from our car lunch break to see a deep machete wound on a mans knuckle that has severed the tendon and chipped into the bone.  So of course I trail along…  The clinical officer (PA equivalent in Uganda) had cleaned out the wound that was full of dirt.  It had happened 8 hrs earlier and the story was that he tried to break up a domestic violence incident and the other man cut him with a machete to stop him from intervening.  I was relaying this to Dr. Isaac and he said to me “No, it is a lie.  This man is the one that was fighting and he is telling you a story to make himself look good”.  I am such a sucker and had told him that he’d been so brave to break up the fight! (through the translator)  Jim was called to assess whether it should be sutured shut now or what should he do with the bone and tendon involved?  Jim felt the man should be referred to a hospital where a surgeon could potentially deep clean it in the OR and possibly pin it.  Deep cleaning is critical for he could very likely get osteomyelitis which can require 6 weeks IV antibiotics. Sadly this was not a real option as the hospital is 4 hrs away by car (he’s on foot) and apparently if he went they most likely would not get the recommended treatment anyway.  Jonathan gently said “In your country that may be possible, but for here the best we can do is suture it shut and give him antibiotics.”   He was eager to learn what we would call “best practices” but knew his country’s limitations.  The knuckle was so swollen since it’d been already 8 hrs that Dr. Isaac was barely able to get it closed.  We will re-assess it in 2 days.

**Today I saw many patients with fever, headache, cough, nausea, diarrhea, etc.  Many appeared to have malaria symptoms but thanks to the lab tests available, all but 2 were negative. (one each for Jim and I).  In prior trips you always had to treat a fever as malaria because we didn’t have a lab test to confirm and it is a key killer of kids.  Hurry up Gates Foundation!  There was a 1 yr old malnourished child that is being treated for malaria with IV meds.  She arrived 2 days ago unconscious and would have died if left in the refugee camp.  Today she was strapped to her momma’s back and looking very alert.  Thank you Lord!

**Yesterday we met a 13 yr old girl in the camp who has been diagnosed with HIV.  She is alone among the refugees with not a single family member, left to fend for herself.  Fortunately she was discovered by MTI staff, tested and started on ARV’s.

**One of my patients today was a 20 yr old male who was dressed in filthy cinched up jeans and a t-shirt.  He was lean and fit and had escaped DR Congo with his father who had since left the camp to settle with another wife, not this young mans mother (polygamy is common in the villages).  He was a handsome young man and his face was sweating profusely. I thought he was going to have malaria.  But his diagnosis doesn’t matter in this story.  I looked at him as my interpreter gathered information and thought of my Luke.  How sad it made me to think this could be my son, alone in a refugee camp having escaped rebels.  How do you make a start for yourself?  How brave would you have to be?  Life is simply not fair.  Oh how I keep having to learn that…

**Then on the drive home a little toddler (maybe 2) was watching our vehicle as we were driving toward him on the other side of the street.  With his little eyes toward us he did not see the oncoming FAST DRIVING truck coming toward him on his side of the road.  Our driver Jesse and Dr. Isaac yelled out the window to “watch out” (in his language) and the toddler jumped into the shoulder foliage, barely in time.  He was safe, but had he been hit we would have witnessed it. This is normal here, toddlers left to themselves to wander or to play with another toddler… a 3 yr old with a large baby strapped to his or her back… Clusters of young children wandering about playing in dirt and happy.  It is nothing short of dangerous but is simply a village “way of life”.

… I love being here with them, it makes me feel alive.  Thank you Lord, for the privilege of serving your people, for You love them all.

Nurse Janey

Dr. Isaac

I LOVE these babies!

This little one ran from us, afraid of the Mazungo’s

    

African thighs like my Liam’s used to be

Jim, PA from Cape Cod

                        Machete wound by man breaking up THIS man’s domestic fight…