Once the blood was in place, the patients dove fully into their new characters. We had them load up into a line of waiting Land Rovers which would escort them outside the MSF gates in preparation for the beginning of the drill. I assumed they would walk to the waiting vehicles, but that is not what happened. Instead, people began to limp, fall on the ground, dragging themselves, yelling out in pain, asking to be carried, flailing their arms dramatically. It was crazy to say the least.
Read MoreMay We Continue to Pursue Peace. /
Together, we celebrate what it means to be alive, to be living and working together; one team made up of many nations. Although our backgrounds are very different, we are-brought together by our shared experience of living in Agok and of caring for and serving our patients. Together, we celebrate the newest country in the world. It is an atmosphere pregnant with hopes, longings and anticipation; all finely balanced upon a fragility, which speaks of defeat, loss and the exhaustion that comes with being resigned to a life of war.
Read MoreEveryone has Stories /
Even when we live together, we segregate ourselves. We form our little groups, find our place of comfort and all too often forget that there is much to be learned from the very people who we find ourselves judging. We miss out on this deep well of great beauty when we fail to take the time to hear people’s stories. I don’t say this as an admonishment. These words are for me as much as they are for you.
Read MoreFirst Impressions. /
After 7 flights and almost 6 days of travel, I have finally arrived in Agok. I took a small, 8-10 seater World Food Program plane to get here and arrived on a dirt landing strip covered with children who barely made it out of the way before the wheels made contact with the earth.
Read MoreWednesday= EPI! /
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 MoreBlood 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.
Fetoscopes, Matoke and African Snow /
Today I was a student. I abandoned the outpatient pediatric clinic for the antenatal clinic, as I am eager to learn more about maternal child health, given that this is something that I don’t get to practice in the states.
God bless the staff here for their patience and for taking the time to teach me when their own workload is so high! I basically spent the majority of the day learning how to measure fundal heights and learning how to ausculate fetal heart tones (both being done the very old school way I might add). Hearing the fetal heartbeat was much more difficult than I had expected. I felt like a complete idiot. The midwife would say, ‘Now, here’s a very strong one!’ I’d put the fetoscope to the belly, then to my ear and hear nothing at all! It probably took me listening to 20 pregnant bellies until I was finally able to hear anything!
One thing I am thankful for is the drive to/from the settlement each day. It takes a good hour each way and yet there is so much to see and so much to reflect upon—this time in the car provides the perfect opportunity. During the daily commute, it is routine to pass 20-30 men, earnestly pushing bicycles laden with Matokes (the Swahili word for Banana). Once the Matoke are weighed and counted, they will be sold to third parties, which will then transport the goods across the border into Sudan. I can’t even imagine how much these bikes must weigh. These men and women are often without shoes and are pushing their bikes up steep mountain passes under the heat of the African sun. The commute is not complete without having to stop for herds of cattle to cross the road. What makes these cattle unique are their massive horns. They are truly incredible. When you see them, you know you are in Africa.
Matoke.
Once you enter the settlement, the road becomes a deep, rust-red and the dust begins to fly as our truck makes the transition from asphalt to earth. Our driver Emma, calls this dust ‘African Snow’. Scattered areas of banana farms can be seen during the first several kilometers. These I have been told are farmed by Ugandans who live amongst the refugees on the settlement lands.
Rare shot of an empty PostNatal Ward.
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