#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