Sunday School

Nothing quite like 16,  2-4 year olds to keep your Sunday mornings interesting. I've only agreed to do this class occasionally so that the other sunday school class (5 years to 15) can better focus without being responsible for their little siblings.

It was only slightly less stressful than preaching. But less preparation time. 

On a side note it felt strange knowing most of these kids since birth. Or even having attended several of their births. 

"Due date", are you kidding me?!

Another few days of teaching this week. The topic was supposed to be family planning but within the first hour it was obvious that that ship had sailed. All the ladies in the class were already pregnant. So I abbreviated my normal lessons and asked them if they wanted to talk about antenatal care (prenatal for the non British speakers) for the last two days.  They all agreed. The next day I tried to bring in some pictures to supplement our discussions.  This might have been a bad idea on my part.  They kept wanting to talk about how I had taken these pictures. It was made increasingly complicated when I showed pictures that were magnified.

This 8 week old baby is actually the size of a bean. The women couldn't really get the idea of the photo enlarging it. 

But they seemed to enjoy it. We talked a lot about nutrition and caring for themselves.  And they were astonished a few things, like that pregnancies are always 34 to 40 weeks long. Two women got up to testify that they had been pregnant for more than a year. They also all thought I was ridiculous for trying to figure out their due dates. Babies come when ever they want.  But overall I think it was helpful and I'm thinking I'll be formalizing my "curriculum" and teaching it again in the future. 

Closed head injury

I got a call in the night last night from some team mates. They were with a 16 year old boy who had been in some sort of traumatic accident and was neurologically compromised and would I please some down to the clinic.....
Oh dear. I never like receiving calls in the night. If it isn't imminently life threatening people wait until morning to call me. If it is life threatening there is usually nothing at all I can do. I've made it a rule to not do CPR here because why? It isn't like I'm buying time until an Intensivist or even an ambulance arrives. The same goes for pretty much any acute life support interventions. Those are all stop gap measures to get someone into surgery or ICU, neither of which are going to happen here.
All of this is going through my mind as I'm headed to the clinic in the dark with my gloves and flashlight in my pocket. The kid was pretty much unresponsive except to pain which elicited some incoherent mumbling and tossing and turning on the table. (GCS of 11= moderate brain injury). The story was he was hit by a bicycle while walking home in the dark. I've come to be suspicious of almost every story I get here and this one was no exception.  Nothing seemed to line up. The boy had a swollen eye with a tiny cut and a small abrasion on the opposite temple. That's it. No dirt, bruises or abrasions on knees, elbows or palms that would make it look like he took a tumble. Besides the swollen eye, his head and neck were normal. The nurse at the clinic had already given 500cc LR and was in the process of giving 1g rocephin though I'm not sure her rational because neither of his "wounds" were even deep enough to need stitches.  I know that I'm going to die of drug resistant bacteria here because of misuse of antibiotics but that is for another post.
Where I'm going with all of this is that there was nothing we could do for this kid. The nearest CT machine is hours away and there is nothing that can be done for a closed head injury. I hate that feeling and it makes me want very badly to go back to work in the States where there is something I can do. Where my ACLS training is actually useful and my answer to practically every issue doesn't have to be "give it time and see what happens".

Night away

I had a really nice night away with my friends last weekend. We just went over to Mbale but it was refreshing. Honestly, we spent most of our time eating and with options like these who wouldn't?!

The Chef's creativity? Yes please! And I'm sure I need some babbly crepes with flakes and other stuff that has been gratinated.

Ronnie ordered the beef teriyaki and it actually was VERY aromatic (I think. If that means smelled very strongly then yes). 

The skewed chicken was actually skewered but good none the less. 

Unfortunately the chocolate fudge in a pool of chocolate sauce left a lot to be desired. Like enough chocolate actually. Who would have though?!

Manifold meal

I've mentioned before that I attempt periodically to cook meals on the manifold of my truck. Most of the time it is because I want a hot meal when I arrive in a place where hot meals are hard to come by without building a fire and slaving over it for a few hours.  Occasionally it is conserve cooking fuel. This last attempt was really because I had no other choice. The reason is irrelevant, this dinner rocked.

I made pot pies and froze them a few weeks back for faster meals. After driving for 6 hours on my last trip out to drop meds off to the health workers it was awesome to have a hot dinner under my hood.

You know you are jealous. Come on out to visit and I'll make you one! I promise it doesn't taste like dust or diesel at all! 

Oh Monday....

It has really been one of those days.....
I've been out of Soroti for a bit so I had a bunch of easy run-of-the-mill stuff to do, but I know better. Nothing here is easy like that. Started off early, I've been out of cooking fuel since before I left for Karamoja so I headed into town only to discover that there still is none to be purchased. More cold meals until the some gets here I guess. Then headed over to the bank to get some cash. Found the ATM wasn't refilled yet. (Often isn't if you go too early on Monday mornings. But it was 9 am and I though it was late enough.) Did a little grocery shopping and to the market with the limited money I had left. Then tried the ATM again. This time it told me that the issuing bank had declined my transaction. Yikes! This has happened before though and it usually has to do with a problem communicating with the banks in Uganda. Sometimes it is fine if you try again but sometimes the machine refuses to give the card back and I'm stuck for weeks without any means of getting funds. So decided to go home to check online. I had a lot of stuff yet to do but without cash couldn't do any of it. All the way back to the house, found my account was fine on the US side. Back to town. Back to the ATM and finally it worked like it is supposed to. Went into the bank to pay my rent, water bill and a traffic ticket. Traffic tickets here are issued, you take them to a bank to pay them then you bring them back to the police station in the city it was issued.  Though the teller reminded me that I was missing a step. I had to go to the Revenue Authority first so they could make the form that that bank can fill out to say I've paid. Don't worry, it doesn't make any sense to me either. Was told that they system was down though so couldn't pay anything anyway. So I decided to go to the insurance office to renew, which was one of the reasons for the ticket. After waiting for insurance for nearly two hours while the woman, on her typewriter! plunked out one finger at a time my new forms, I finally had something checked off my to-do list. I tried not to think about the fact that I had spent all morning in town and had not successfully paid my rent or gotten cooking fuel or paid the water bill or dealt with the ticket .... I headed off to the URA office to try to get the form that I need in order to pay the traffic violation. Another long wait but finally managed. However, as I was gathering my forms and getting ready to leave I was told that I needed to go to Crane Bank. "But I have other business at Barclays, can't I go there?" Was told no, she didn't fill the form for me to go to Barclays and she didn't want to redo it. Are you kidding me?? So headed over to the new bank where I stood in line again. Finally got up to the window and passed my papers and money through to pay the ticket. She seemed to spend an inordinately long time calculating my change. When she finished up with that and passed my papers and balance back I asked if I could pay my water bill there too. She said sure and handed me a form and I was elbowed off to the side by the next person in line. (This is very normal as three or more people can be trying to conduct transactions at a teller window at any given time). As I got back to the window to pay the water bill I realized that the change she gave me was all wrong. I had given her 100,000 and owed 80,000. Even for me, who is terrible at math, I know that the 37,200 she gave me isn't right. So I kept 20,000 and passed the rest back explaining that she gave me too much. She snapped at me that there are bank charges that I also have to pay. I paused then asked what the bank charges are. She didn't reply and I said "Anyway, especially if there are more charges you've given me too much." I passed the papers back and showed that I owed 80,000, had given 100,000 etc.... She snapped that I had to give the 20,000 back. I asked how much the bank charges are. She immediately accused me of trying to cheat her. What?! I was trying to return some money because she had given too much! I was really wishing at this point that I had just kept my mouth shut.She started to work on the water bill that I'd also given her and it wasn't until she passed me those finished forms back that I realized that now she'd given me no change. Trying to be as non-confrontational as possible I asked how much the bank fees were and that she still owed me something. If looks could kill..... anyway she gave me back 17,200 so I'm assuming the fees were 2,800 but they could be anything for all I know. Deep breath and headed back over to the other bank, hoping their network was back up to pay my rent. Only a few more minutes standing in line and finally I though I was finished. I was almost all the way home, trying to figure out what I could make for lunch without any cooking fuel, when it dawned on me that I had not gotten the URA forms back to prove that I had paid the ticket after all that. I almost swore out loud as I turned the truck around. And to make matters worse when I went back in I learned the the teller I was interacting with was now on her lunch break. I explained to the person under the "customer service" sign what I needed and she said I just had to sit and wait until the teller came back. I decided the smartest thing was for me to go get some lunch of my own and come back in a bit. I was feeling slightly better after a chipate and coke. Not better enough though to keep my comment to myself when the teller had the nerve to say "I can't believe you left your form here."  "Well, it was on your side of 2 inches of plexy glass because I had to give it back to you because you screwed up my balance so maybe you caused me to leave my form here!" Very christian, I know.

On the up side I got all these lemons for less than $0.20 (500 shillings) so I'm going to be having some lemonade today.

Finally really raining!

The dust is turning to mud!! I can't believe I'm this excited about the rainy season but this seems to have been a very long dry season and an exceptionally hot one. I'm tired of chapped lips, cracking feet and dust every where every time I'm in Karamoja. Dust in my hair, dust on every surface of the house, dust in my sheets, dust in my drinking water.
But I'm even more excited about this for my friends in the peace villages. I've seen how badly their gardens did in the first rainy season, in which they could count the number of times it rained on one hand. We are praying for some long steady rain to water their crops so that they can have a good harvest to carry them though the next dry season!

From "A Life Overseas"

This post Is Jesus a Liar? was written by a missionary who also lives and works in East Africa.  It was a great reminder to me. Check it out.

Other bloggers

I'm up in Karamoja for the next few days, so until I come back and update here are a few of other people's blog post that I really resonated with.

I don't even want to share this one because it is so true! But I'm all about honesty here in my blog so please check out this post someone wrote about 10 things we don't want to tell you.

10 Things Missionaries Won't Tell You

Preaching

So one of the downfalls perks of being a missionary is that you will be called upon to preach. Regardless of if you have any training or appropriate skills or even have anything legit to share. People just assume that if you are a missionary you should be able to do this thing. And I go both ways on it. I guess, from their perspective, if I have the audacity to call myself a missionary I should be able to preach what I believe. But I grew up knowing that preaching is not something to be taken lightly. Those who do it have significant training, hours to prepare and a special call from God to shepherd.  And I'm not even sure what I think about women preaching.

But all of this aside, on Saturday afternoon I was asked to preach.  I was sorely tempted to say No, but I've told my feelings about this to the person who called so I kind of figured if he was asking, he didn't have a lot of other options. It was for the small village church I attend outside of Soroti so there is a level of spiritual maturity that prevents me from using the ultra basic lessons I have prepared for Sundays in Karamoja.  What made it harder was that I was out in the village following up on some patients and didn't get home until rather late on Saturday night. And didn't really know even what to teach about. 

So, early Sunday morning I finally flipped my journal open and decided to just share what God had been teaching me about- Priorities. 

 If you chase two chickens you will lose them both. 

 Luke 17:20-35 Once, on being asked by the Pharisees when the kingdom of God would come, Jesus replied, “The coming of the kingdom of God is not something that can be observed, nor will people say, ‘Here it is,’ or ‘There it is,’ because the kingdom of God is in your midst." Then he said to his disciples, “The time is coming when you will long to see one of the days of the Son of Man, but you will not see it. People will tell you, ‘There he is!’ or ‘Here he is!’ Do not go running off after them. For the Son of Man in his day will be like the lightning, which flashes and lights up the sky from one end to the other. But first he must suffer many things and be rejected by this generation.

 “Just as it was in the days of Noah, so also will it be in the days of the Son of Man. People were eating, drinking, marrying and being given in marriage up to the day Noah entered the ark. Then the flood came and destroyed them all. “It was the same in the days of Lot. People were eating and drinking, buying and selling, planting and building. But the day Lot left Sodom, fire and sulfur rained down from heaven and destroyed them all.

“It will be just like this on the day the Son of Man is revealed. On that day no one who is on the housetop, with possessions inside, should go down to get them. Likewise, no one in the field should go back for anything. Remember Lot’s wife! Whoever tries to keep their life will lose it, and whoever loses their life will preserve it.

I don’t want it to ever be said of me that I was busy eating, drinking, buying and building and then my end came. My priority needs to be the kingdom of God! I know that I get busy and distracted with the little stuff, but I’ve begun praying every day that I would seek first the Kingdom of God. That I would allow God to make my priorities His priorities. 

In true Ugandan fashion, and after translation and some visual aids, the sermon was much longer than this. But you get the gist of it. 

Teaching Janet reading...

Almost seven months ago I realized that one of the girls that goes to church with me every week, who is in the equivalent of 4th grade, is completely unable to read. I had asked her to read something and she started crying and said she couldn't so I thought I could encourage her and build her confidence a bit. I invited her over and gave her a spelling test to evaluate her reading level. This is the test. The word on the left is her guess and the word on the right is her "correcting" her test with my help. Turns out she didn't even know letter sounds. She knew letters, sort of, but her whole school experience was simply copying what the teacher had put on the board. I have no idea why they kept promoting her but they did and now she is 13 years old and 100% illiterate.   So I agreed to tutor her and we started at the beginning. She mastered letter sounds fairly quickly and we moved on to simple word families. (Cat, hat, sat, hot, pot, not etc...) and she also mastered those. But she remains unable to sound new words out.

She has roughly 100 words that she can read because she has learned them, made a flash card and memorized them. When I add a new word or we try a simple book she can't read it for herself initially. I have to tell it to her and she has to go through her system to memorize the words. No matter how many times we practice sounding things out she can't do it. Often she mixes the syllables. Or by the time she gets to the fourth or fifth letter she has forgotten what the first sounds are. Or she manages to say all the letter sounds but just can't put them together for words. Any suggestions?!

How to blog about the deeper challenges....

I think I have figured out why the blog tapered off so much this year. Besides, #1, straight up laziness, and #2 lack of desire to process life and think deeply, there is #3. Somethings that I experience I just don't even know how to explain...

The other day I was so embarrassed by all that I own. I mentioned the snake in the hut in Lormoruchbae which led to the need to "smear" and in order to do that everything in the house had to be taken out and piled outside until the dung could dry and harden. Try to pretend everything you own is put in your front yard where every one of your neighbors can see it. And pretend your neighbors own nothing.
As I was looking at all the stuff I "need" to survive up here I hated it all. But I know I really do kind of need it. The kids all kept wanting to play on the mattress. And I really wanted to let them because they have never experienced a mattress before. Most of them sleep on plastic feed sacks, if they are lucky they have a thin blanket too but I know for a fact most don't. What was the harm in letting them play on the mattress?  That was the kind half of my brain. But the pragmatic half was screaming that these kids are filthy! The mattress was in the dust on the ground (there is no ground besides dust in the village) and there is NO way for me to clean it and I actually do have to sleep on it and I really can't let them play on it.
Several of the women came up and asked for basins or jerry cans and well, I do have 4 each. These ladies probably have one or two for their families of 6 or more people. But 4 jerry cans hold only 80 liters of water and when I am up there for several days at a time 80 liters of water for cooking, washing and drinking is actually not that much. And basins- also for cooking, bathing and washing, 4 seems reasonable. I "need" them! I can't just give them away. But ugh! That is so selfish of me!! I hate the way that sounds even as I write it.

Getting dirty.

Sometimes I just don't like getting my hands dirty and I'm not just saying that because I still have cow dung caked under my fingernails. (The house in Lormoruchbae needed to be "smeared" because a snake was found in it.  "Smearing" involves taking large amounts of cow dung and well... smearing it on every square inch of the floors and walls. Supposedly it keeps snakes out and I believe it as it seems like it should keep everything out.  But it actually dries to a nice hard, less dusty surface, better than the mud walls and dirt floor actually. However, consequently three days later I still smell like cow poop.) Anyway, I'm back in Soroti, after a good meal, a shower (cold though, Soroti has more amenities than Lormoruchbae but evidently power is not one of them at the moment) and my much more comfortable bed... and I can't sleep. I keep seeing the little girl with the liver failure (see the last post).  I'm frustrated with the mother for not valuing the life of her daughter more. But I didn't really do anything either. Should I have offered money and more help in addition to transport?  I try so hard not to create dependency or fall into the mindset of being people's savior but maybe I do too little. What about the extremely malnourished little girl?  I have formula and other protein rich foods. Should I give it?  But where is the line between empowering the family and keeping them from taking care of themselves?  Help and treatment is in Lorangachora, they just have to go get it but it will take some effort and sacrifice on their part. However, if the mother is away from the garden too long will that sacrifice hurt the other children of which I'm sure there are several?  Is it unreasonable of us to expect her to put the needs of the one sick one ahead of the entire rest of the family?  Is this why God put me here- to give food and money?  But how can I help without hurting? I clearly saw the harm of continuous aid while in Nakayot yesterday and I don't want the people of Lormoruchbae to develop those same problems. So we absolutely can't do the same thing here, even if it feels generous and reasonable and helpful and charitable.  It really does devastate communities.  How can I better communicate that I love people and want to help them without just giving them "stuff"?
This would all be a lot easier if I hadn't gotten my hands dirty this week. If I stay further way,more at arm's length, don't get to know them as well. Bring medicine and teach the health workers then go back to Soroti. It doesn't hurt so much then. I wouldn't lay awake at night....

Been a hard few days....

Lorchoro 2 weeks ago, skinnier now. 

I've been up in Lormoruchbae for awhile and the suffering hit me harder than some other times. There are several girls who I often do stuff with because they have the patience to teach me (or I am highly entertaining to them, which is probably more likely).  Lorchoro and Angelnia.  They are both between the ages of 12 and 15.   I couldn't help but notice this time how skinny they have gotten. Neither of them have any extra weight to begin with so it is disconcerting to see them loosing.
 The evening I arrived they brought me a baby who maybe weighed 8 kg (about 18 pounds) and they told me she was sick. As I unwrapped her blankets it became obvious she was extremely malnourished. She is 2.  She looks like a little old lady. Her skin is wrinkled and her little legs are no bigger around than my thumb.  (As a reference point a normal two year old should weigh between 12-18 kg or 26-40 pounds. For those who care she had a MUAC measurement of 80mm- I've never seen that before, even in Amecet kids.)  That night I got her started on ORS (oral salts for re-hydration and to replace electrolytes which you have do to before you can start re-feeding or fatal arrhythmias can develop).  The next morning I met together with the mother and both VHTs. I learned that the baby was from a more remote village and the VHTs didn't know of her. The assured me that if they had known it was that bad they would have intervened. I believe them because I've seen all of the kids within their village and a few are malnourished but none critical. Anyway, "we" decided she needed to be treated at the clinic as she was clearly very ill. I drove them the 20 km into the clinic but honestly didn't figure I needed to stay as I know WFP is donating so they could receive free treatment.

I was very discouraged to learn the mother decided they couldn't stay for inpatient treatment and walked back to the village.  She had received a few plumpy nut packages but I know the clinics can't give them out in any volume as they are used wrongly or sold or whatever. I just hope they go back next week for more. But I also know it is an entire day walking and for the reasons the mother decided not to stay she also may decide not to spend an entire day walking the 14 miles back and forth from the clinic.
The next day I headed out to Nakayot to check on the VHTs out there. I was happy to find one of the guys with a patient.  He asked me to go back to another home he had just been at so I could suggest what to do as he didn't know. Another 2 year old girl. This one with a giant liver. Both the liver and spleen were easy to palpate. She had what looked like acites too, and  non healing wounds on very skinny arms and legs. She was lethargic and they reported she had diarrhea. I know that of the six drugs the VHTs have there was nothing for her and of the twenty I carry there still was nothing for her. I explained that the best place for help was the hospital. The mother just nodded and said nothing. I told them I would provide transport if they changed their mind. The VHT told me they wouldn't go. The mother, who looked less than 18, has two other children and the father isn't around. The hospital is 200 km away and she has no money for food or anything while they are there.
The next day I was back in Nakayot for other reasons and there was so much begging. A group of maybe 30 or 40 people were gathered around asking for food, soap, medicine, clothes, money, anything. Unless you have been in a press of demanding frustrated K-jung yourself you just can't even imagine it. The will grab at you to get your attention, getting louder and louder to be heard over each other.  Pushing, shoving small babies toward you, lifting their shirts to show hollow stomachs. One woman who is well known to CLIDE pushed to the front and showed us her breast. It was large and swollen and had that classic "orange peel" look of advanced inflammatory breast cancer. What do I even say to her?!  Clearly she is in stage 3 or 4 already in a place where NOTHING can be done for cancer.
Just as we were leaving a group of women came running up to us asking for transport to the hospital "now, now!" One lady held up her cupped hand and said a baby that size was very sick. So we drove the truck as near to the house we were being directed toward as we could get and as I got out I was handed a tiny bloody bundle. It was a premature baby who evidently had just been born. He was cold and grunting and had sternal retractions and I didn't see anymore than that as I wrapped him tightly back up in his blanket and asked where the mother was. She shortly also came out looking pale and shaky. I'm pretty sure she had delivered within the hour. We tucked the baby under the mother's shirt, tucked them both in the truck and took off of the hospital. The baby stopped breathing a few times on the way so it was no surprise that within a few hours of arriving he was pronounced. There was just nothing the hospital could do. They are the best hospital in all of Karamoja but they don't have the capabilities to intubate adults let alone premature neonates.
It is all just a lot of sickness and suffering and hunger and death.....