The definite highlight of the day was seeing a kiddo come into the clinic dressed as Santa Claus (his mother completely unaware) and seeing another kiddo named 'Beyonce' (not the typical Congolese-refugee name) ;)
Read MoreUganda
Blood Pressures & Babies /
Spending so much time with pregnant woman here in the settlement and being so close to life and death on a daily bases has caused me to do a great deal of thinking, specifically about the differences between delivery in a country such as Uganda and the U.S; the differences not only in the delivery itself but also in the preparation leading up to the birth. Back home, we have the power and the knowledge to be in charge of our bodies (in most cases) from pre-conception to post-delivery. We can plan whether or not to become pregnant and after our urine dipsticks display a '+', we have nine months to fully prepare for the coming child. We order parenting 'how to' books, attend parenting classes and workshops, practice prenatal Yoga, consult with our friends who have gone before us, outfit the baby's room and line up friends who can deliver meals. Once the delivery gets closer we go to work in our search for the perfect midwife and if we are lucky, a doula as well. We visit birthing centers and hospitals and start choosing how and where we will bring new life into the world. Through every step of the process we are receiving routine antenatal care, which includes ultrasounds to tell us whether all is well inside the womb. In Africa, and many other areas of the world, women are never consulted about the decision of whether to get pregnant. Theirs is a life of subservience and reproductive surrender. There are no books for them to read or classes to attend on how to be a good parent, there is no one telling them what they should or shouldn't eat as the baby begins to grow inside their wombs. As their gestation period winds to an end, there are no ultrasounds, no fancy birthing suites and no pain medications. They do what their ancestors have been doing for millenia before them. They squat on a dirt or concrete floor and bring new life into the world. Their bodies know what to do and for many, both baby and mom come out of the experience healthy. The problem however, is that for the majority of women, this is not their story. According to the WHO, almost 800 women die from pregnancy or childbirth-related complications around the world every day, with 99% of maternal deaths occurring in developing countries (primarily Africa and areas of Asia and the Middle East). http://www.who.int/mediacentre/factsheets/fs348/en/
Read MoreMy first paracentesis, for starters.... /
At six years of age he was unable to walk and appeared to be perhaps 3 years old, his head being completely disproportionate to the rest of his body which had stopped growing early into his development.
Read MoreThe Challenges of a Rural Outpatient Clinic /
Although I am supposed to be here as a "Medical Expert" I often feel like I am the one being taught. As to be expected, I have been seeing lots and lots of children in the outpatient clinic. Not only do I work with adults back home but as a nurse I am not the one diagnosing and prescribing treatment regimens. Thus, anytime I do this type of work abroad it is incredibly challenging. In addition, each country has its own system for data recording and management. During my first day of seeing patients I completely failed at the paperwork portion of my task. Again, some "Medical Expert". It all came down to basic communication, which is actually quite challenging. While English is spoken amongst the health care workers and staff, the accent is so thick and the words used to describe things is quite different from what I am used to. Then you have the added challenge of working with an interpreter; which comically comes with the same set of challenges regardless of which country you are working in. How I wish that I could speak all languages! For whatever reason, the interpreters always seem to get more distracted, overwhelmed and exhausted and thus feel the need to take more breaks than the clinicians prescribing the care and seeing the patients. Translators also take it upon themselves to assume that they know what it is you want to ask the patient before the words have left your mouth, and I often doubt whether they are actually translating my instructions and questions versus communicating what they feel is best. Local translators get so used to working in their given context that they become the ‘doctors’, thus bringing the added stress of having to argue with and explain the bases for your medical decisions to those whose job is to interpret.
I also find that it is common across different cultures for mothers to bring their kids to the clinic for a wide variety of ailments that can readily be treated at home; such as the common cold/flu. Almost every child came in with complaints of fever and cough, however very few were actually running high temps and the majority of those kiddos tested positive for Malaria. The other kids had nothing more than a common cold, however the caregivers always insist that you prescribe antibiotics. There are many generalized, non-descript complaints for which there is little that I can do. Many kids are in need of parasite treatment and meds for fungal and bacterial skin infections. Other kiddos come to the clinic with chronic and acute ear and eye infections and one kid today came in reporting tooth pain. When I looked into his mouth I saw that his two back molars were completely rotted out! Apart from the visiting ministry of health dentist who comes once a month, here is another example of a situation where I can do very little.
Malaria! /
Never before have I seen so many cases of Malaria! Probably 1/3 of the kiddos that I sent for testing today came back positive. What was even more shocking to me was the number of severe pediatric malaria cases. Unfortunately, the triage system is not so hot here (we will be doing some triage teaching for the staff next week). I am not sure how long this young boy had been waiting to be seen but while his mom held him, soaking wet from the fever he had just broke, a group of angry women vied for my attention, demanding that I see their kids who had ‘treat at home’ runny noses. It was obvious that this boy was not well. By the time I saw him, he was barely responsive. His RDT (Rapid Diagnostic Test) came back positive for a high load of falciparum trophozites (the strain of Malaria, which causes cerebral malaria). Until yesterday, I had never before seen a case of Cerebral Malaria. Now I have seen several cases; all in small children. Meanwhile, on my drives in and out of the settlement, I spot mosquito nets adorning chicken coops, rooftops and walls...
Women begin to gather around the OPD as a pharmacist begins to distribute meds
Women Matter- Reflections from NW Uganda /
“It is a woman’s fault if she becomes pregnant, not the man’s. Only she should be punished.”
Read MoreWhat is Nakivale? /
In 2008, UNHCR (United Nations High Commissioner for Refugees) made the decision to resettle 40,000 refugees in the Nakivale settlement in NW Uganda, after fighting escalated in the North Kivu district of the Democratic Republic of the Congo (DRC). Both the Nakivale and Oruchinga settlements were first established in 1959 by UNHCR, thus some families have been living on the settlement for over 50 years! UNHCR has now handed over all of the medical care to Medical Teams International which currently employees and trains all of the national staff in the 6 health centers spread across the settlement.
The settlements host refugees from 8 neighboring countries: DRC, Somalia, Rwanda, Burundi, South Sudan, Ethiopia, Eritrea and Kenya. Although Nakivale is a refugee settlement, Nationals are free to live on the land and take advantage of the services offered, such as schooling and healthcare. Although the concept seemed strange to me at first, I now understand that this policy ensures fair and equal treatment for both refugees and nationals, especially considering that many Ugandans were living on the settlement land far before UNHCR decided to take it over. The settlement is divided into 21 zones and has 76 registered villages. In order to avoid tribal conflict, each zone is populated by a different ethnic group. The settlement encompasses 71 square miles and is now home to over 76,000 refugees.
On arrival, the refugees are first taken to a reception center where they are registered as asylum seekers until they go through the refugee eligibility committee. Once given a status as a refugee they are given a small plot of land and are provided with a ration card so that they can receive food from the World Food Program. They also receive basic supplies such as a plastic sheet, cooking pot, jerry can and a few small tools for land cultivation (Uganda has very welcoming policies for refugees. Most countries are not so generous).
Refugees lingering outside the Resettlement Office
Somali women waiting for refugee status updates to be posted on the UNHCR Notice Board
The settlement is actually quite beautiful. It begins with fields of banana plantations and ends in a dry savannah-esqe valley that is littered with towering anthills, Acacia trees and cows with tusks that could easily impale a person. The rust red road, which descends deep into the settlement, offers breathtaking views of Lake Nakivale. Supposedly the lake is home to a family of crocodiles, however rumor has it that their numbers have dwindled, along with the exotic snakes and local monkey population as the numbers of Congolese refugees have continued to increase. The joke goes,
“Meat is meat if you are Congolese.”
A few iPhone and 'through the car window shots'