SATURDAY AFTERNOON AT OUR HOUSE

THE SPECTATORS

THIS IS A LOOK INTO THE WINDOW OF HOW THINGS ARE DONE HERE.  WE HAVE A LARGE TREE IN OUR BACK THAT GIVES WONDERFUL SHADE BUT WHEN THE ROOTS START COMING OUT OF THE GROUND IT NEEDS TO BE CUT.  THEY HAVE SEVERE WINDS HERE THAT KNOCK TREES OVER ON TO PEOPLE SEEKING SHELTER UNDER THEM SO DOWN THEY COME. FEELS LIKE A CRIME BUT "THIS IS AFRICA" AND THIS IS HOW IT IS DONE.  A BLOG IN PICTURES.

THE SCENE LOOKING AT MY BACK DOOR

WOULDN'T A CHAINSAW WORK FASTER?

NEEDING TO REST

CONTINUING FROM A SATURDAY IN THE BACK YARD

GUYS FROM THE JAIL RETURNING HOME AFTER BRICK MAKING

PUTTING ON THE SKIES  SEE THE WOMEN IN BACKGROUND?

SKIING DOWN A HILL IN AFRICA

MORE HELP IN THE TREE

MORE FROM A SATURDAY

SPECTATORS BECOME PARTICIPATORS

DUE TO UNFORESEEN CIRCUMSTANCES: (I DON'T KNOW HOW TO CHANGE IT) YOU MUST START THE BLOG FOR SATURDAY THE 25TH POST BELOW AND THEN COME TO MOST RECENT ONE POSTED.   TECHNOLOGY IS NOT WHAT I DO BEST 

Thanks Barb and Dan!  The kids love it...

Happy Birthday Auntie!

Buying Clothes     Happy Birthday Auntie!

With all the hand washing of clothes we do and the severity of the soap on the clothes and the hot hot sun taking color from them, after 6 months we are in need of things. You can have new made as there are many tailor schools here and many tailors. If you are having a tailor make your clothes be sure and see how they put the zipper in and you can tell if the rest of the garment will be made. I haven''t seen a zipper foot for the sewing machines here so the tailor uses other skills. So rather then hassle with that we went shopping in the GAGA market where people buy bundles of clothes take them home wash and iron them and put out for sale. Everything in our closets we packed up before we left probably beat us here and is cleaner then I ever got it

NEED A BELT?  EVERY SIZE IS HERE

 The market has thieves too that follow you to pick your pocket so we are told that you go and look then you come back and buy as prices go down if you walk away and come back. I took some pictures. The market in the 1^st pictures is a temporary one market. They set it up until 2pm and then take it down because it becomes the fish market from 3-6.

FRESH NILE FISH

 That is when the trucks with fish from the Nile come. Tom is not a big fish eater so we haven't tried it yet but I have a friend who is, so soon, we will try that. But, the fish smell lingers on the display racks(? see picture) so we are hesitant to buy clothes that already have a faint fragrance and then sweat in them to add our own. You can see by the size of the market that there are a lot of choices. One of the other volunteers has walked me around so I kinda know a few things but not all. I think I can spot a pickpocket though...

SEE A SHIRT YOU LIKE?

I did not get all the pictures I hoped and we did not get any clothes as the hot hot sun is still draining our energy away when ever we are out in it. But we did look, and didn't get pick pocketed. Some more shots of Africa...Marcy

HAPPY VALENTINES DAY FROM UGANDA
WE KNOW WHERE WE'RE GOING DO YOU?

Used car and 4X4 lot in front of the hospital

How old is this Massey Fergason?    Anyone have parts for it?

Happy Anniversary MOM & DAD 58 years             Life on the Wards        Please pray        2/12/2012

When events happen that I feel so helpless about I just want to come home and blog. I have resisted this time so I can have time to analyze. I want to think I am not just biased and self serving and maybe seeing myself as a martyr. So, this is life in the OB ward where people come to have babies. Some come because they want to, some come because they live in a village and the home birth did not go well or the village health person (one village this person is a nutritionist) is unfamiliar with what to do next, if there is a hang up or problem, so they get sent to the District Hospital here in Arua as we have an obstetrician and a surgery. I am only looking on the wards for students to make sure they are showing up and not “dodging”, (disappearing to some where else) these are the work force for the hospital as well as learning time for the students. “Baptism by fire I call it”.

Who is that strong man?

So, I wander in the delivery part of the ward at about 9AM and they have a mother in labor and they know she has a abrupted uterus so they are planning surgery. They also have a mother with baby having shoulder distocia who needs surgery, a mom who has prolonged labor with failure to progress and water broke meconium stained, waiting for surgery. And 1 more mom in need of a C Section. The Theater (which they call the surgery) has one large suite and I don't know how many sets of instruments and 1 Dr to do the surgery’s. So, it is a bad day for babies today. (Interesting there is a team of 5 residents from Northwestern in Chicago here following around the DR in the specialty they want to pursue for a week to observe) I asked the woman in the OB dept what she has been seeing and she shakes her head, widens her eyes, and says “A lot of stuff described in a text but not often seen”. I won't bore you with detail of all these problems, but I needed to leave, I find it breaks my heart to even know about what is happening. I went to check other students in the wards and by about 1 I got around to the theater. They were doing surgery on the second mom. First mom is back on the maternity post delivery ward where mothers whose babies have died or who have cancer are kept. She recovers there. I don't know how closely monitored they are after surgery. The indicator of how well you are doing is if you can take tea. It is highly sugared, so it gives you “strength”. I asked the surgical charge nurse how the mom did with the abrupted uterus. “She is very weak, the baby died and the mother needs blood but we do not have any at the blood bank.” 2 days before this, I was talking with a student in the theater and she was waiting for a mom who had an ectopic pregnancy and before they did the surgery they were waiting for blood for a transfusion. There was 1 unit in the district for her and it had to come from a hospital ½ hour away because they had power all the time (thanks to the Germans building them a hydroelectric plant) to be able to keep the blood refrigerated and we do not. So, with 4 critical surgerys in one day (which may really have started the night before but with no power and no fuel you cannot do surgery until sunlight) you have no blood in the area. T I A

Next day I am wandering again finding students and there is a hospital wide meeting on quality of care. All the charge nurses of the wards and clinical officers are there along with management. The staffs rated the hospital on how well they thought it was doing

Excellent

Very good

Good

Fair

Poor

Very Poor.

Dumb me stuck up my hand at fair, my criteria is some people live and go home but too many are dying. The people of the hospital rated it very good. I wonder what poor looks like? (Maybe that is what the health centers are with a nutritionist as educated staff for all the health problems. Each sub county village has a health center with a assigned staff. Whether the staff actually comes or not is another matter.) So, I need all of you to pray!!! How can his be different for the Ugandan people? How Lord, would you have me serve? Please Lord Jesus, return quickly to make the world anew in your order. Thanks, it helps me to know I am supported. From Uganda where the full moon is spectacular, the breeze today is cool, and the church services are inspirational. Marc

Newer ambulance with no fuel.

HOW OLD IS THIS TRUCK AND WHAT COUNTRY DID IT COME FROM?

You may wonder what these pictures have to do with this blog. They don't. I know guys are reading this too so, I have left out details of medical words as my son said that is gross so I included pics of the various junk laying around the hospital. It dies where last parked and if you want to move it or revive it, it now becomes a way of someone somewhere to try and make money off it. The people interested in it are poor, so it stays were it is and the constantly blowing dirt of Africa eventually buries it. See tires. Enjoy the pics boys... Does anyone know since the super bowl is over where I can just watch the commercials?

Happy Birthday Jake      2/4/2012
T I A Samson or Doing what you can, with what you have, in the time you are given

What a week this has been! I have tried to stay out of the life of the hospital and only check to see that students are in the appropriate wards and aren't doing what young twenty somethings do rather then go to the wards and work with minimal supervision and minimal nursing staff for all the patients. So, I went to the eye ward and 2 nurses were coming back from taking a patient to the surgery ward across the hospital grounds on a cart that is metal because the pad on it has disappeared. I took the girls back because I wanted to teach them how to do a Glasgow coma scale to determine the patients level of consciousness. The 15, maybe, year old had been riding his bicycle and was hit from behind and knocked to the ground by a boda out in a village. He had come to the hosp Saturday, laid in Eye ward until Tuesday when he started loosing his level of consciousness and being combative. His visible sign of injury was a torn lower eye lid on the right a very very swollen R eye and his R pupil was dilated and would not react. The clinical officer that saw Samson wanted an X-Ray done as that is the diagnostic tool we have at the regional hospital. The girls and I went to X-Ray and they aren't doing them today because we have no power and no fuel to run the generator. I asked who I talked to about fuel and they sent me to administration. I had been there on Monday and met the personal officer Geoffery because the administration was on leave until mid Feb. and may be resigning anyway. The head of the Hospital Accounting was sent to Japan for a 3 month course to be back in March, so personal is holding down the fort but if I really needed something the head of the mental health ward was in charge for hospital related things. So I am talking to personal and explained the situation:

You have a young boy with a head injury that needs an X-ray to see what is happening

You have an X-ray machine that is staffed but no power so staff is reading the paper and charging there phones with the solar power

We need funds released for fuel, how do we do that?

The only one authorized to release funds is in Japan, can I pay for fuel? His response.

So, I remind Geoffery that my paying for the fuel will not help his people. This is the largest hospital in this area, it is a referral hospital, and this is what people who come here for help receive? He was apologetic and said “Yes, that is the problem here” of which I have heard many many times, like I have identified the obvious. But, I am now becoming smarter and ask what can be done for your people that this will not continue? Now, he gets me another man who works in the accounting dept and he listens to the story and allocated for fuel for an hour to run the generator so the picture can be taken. I go back to X-ray tell them I have fuel approved and that I want the young man in Surgery done first. Because Surgery is a clean (no active infection) ward people with no active infection go there. So I came back to the ward and talked to staff and went to the mother and told her when she heard the generator running outside to get a nurse to take her son to the X-ray thinking they would find a wheelchair and staff would make sure it was done. X-ray is another building away from the surgery building. I went back to X-ray and there sitting on the bench is Samson with his mom. It's like do you know how bad you really are kid? TIA He got the pictures at 12:30ish and I walk back to the ward at 4 to see what the plan is for this young man. No one looked at the X-Ray yet... The orthopedic surgeon looked at them but we needed the head surgeon to see them to write orders. Well Dr. LULU is in Kampala having a heart workup so Dr Amandu looked at them. This man I know because Sherry the woman at the catholic center with the big house, had a maid that got hit b a boda and had a head injury just before Christmas and I followed her around and got her transferred privately so she could lay down because they had $ for that. I had worked with Dr Amandu before and he was great. He looked at the X-ray and said the boy needs to be seen by the neurosurgeon in Kampala. ( He had a shattered lower orbital bone and a dent in his R frontal lobe). I asked how he would go and Dr said there is an ambulance but he doubted they would take him because it is so far. Off to Geoffery I go and am told the tires are bad the vehicle needs to be serviced and we have no fuel. So you ask the family, can they afford to take him? which would be by 8 hour bus ride and then a taxi in Kampala to the hospital. The roads in Kampala give you a head injury as they are full of rocks and various ruts at the taxi park that is 6 blocks away from the bus station so ou have to walk to it? No, was my guess, they looked like very poor peasants from the village and no was the answer. Good, I wasn't sure he could survive the ride. Well we can give mannitol and keep him here but it may not be good. So, I go talk to mom explain through an interrupter and they agree to have him stay and then I pray with the family. Should have started there but I am still slow to learn. Now, the nurse comes out and said they have no mannitol and the family will have to go buy at one of the pharmacy's in town. TIA I asked why they couldn't go to the pharmacy and just “pick it” as they call it. No, only the charge nurse who only works days until 2:30 can order it. She of course is gone. So, I take the order and go to pharmacy and write a note on the order for 10 take 4 and go back to the floor. The nurse now takes vitals after much encouragement (like I am almost yelling in my stern get off your butt and do something voice) as those have not been done. She said they have no stethoscope so she puts the cuff on and looks at the numbers as they bounce and calls it good and they don't have a thermometer so she skips that part but he is breathing and I ask for coma score, but guess what, I didn't get one. I gave him my own and he was still okay and then she puts the IV back in and hangs the mannitol for 2 hours. There is no rate ordered and she couldn't go find the Dr, no, she just hangs it to run over 2 hours. I again explain to the mom that Samson will get 4 of these and to keep the other 3 at the bedside so they don't get used for someone else. The family thanks me and off I go. Next day I am checking on students again and stop to talk to Samson and his mom. I do the coma scale and he is still confused but seems otherwise a little better. He is eating and drinking but his eye hurts. So I asked if a patch could be put over it to keep the fly’s off it. They comply and the mom tells me they have hung no more mannitol since I left and she had told them he needed it. This time I find the charge nurse and ask if anyone knows what is happening with this child. No, no one told us about this. I haven't seen what report to the next shift looks like if there even is one which I doubt. So, she apologizes and off she goes to hang a new one. Today I went back to check again on Samson and he is gone. His neighbor in the ward said he went to Malago in Kampala. I didn't ask how. I have 2 other stories to tell, but I will post another blog so this isn't so long. TIA form the hospital where if you don't die here you have a pretty good chance of coming back to try again.