This must be Monday, the beginning of the week scramble for school uniforms (are they shrinking that fast, or are the kids growing that fast?), doling out yoghurt and granola, pasteurizing the morning's abundant fresh milk, making tea for my workers, checking the internet, looking for a misplaced school book, making lunches. A patient's mother arrives at 7:30 to tell me that her son (Paulo, thanks for praying for him!) finally got his surgery on Friday, to close his abdominal wall and allow him to urinate normally. She is followed by one of my students reporting back from his interview trip to the intensive Christian discipleship and boarding school work program . . no results yet, so we sit down to make a strategy and budget for beginning school locally in case he is not admitted there. Meanwhile my three kids lug their 20 pound back packs (!) onto their backs and get their bikes and helmets and head off to school, I finish my coffee and show my workers where to plant some papaya seeds. A little milk and fruit for the bush baby, and I'm off too, to the hospital.
On the ward Heidi helps me get started, then she has to head out to a smaller health unit where we are re-training nutrition outreach workers to begin another cycle of the Byokulia Bisemeya ya Bantu (BBB, good food for people) program. As soon as she leaves I discover that three one-month-olds with similar diagnoses (pneumonia) but dissimilar sizes (2, 3, and 4 kg) have had their charts mixed up, and it since mothers often don't read and don't seem to concerned about what their kids' name is (seriously I'm holding the papers and reading the names and they are all looking at each other unsure), it takes some doing to sort it all out. As soon as we get that settled (and no harm done, all were on the same antibiotics) . . . an unconscious child is rushed in, a huge looking 4ish year old, completely zonked. Mother and aunt had left him with other kids, no one seems to know what happened, later dad thinks he was hallucinating during the night . . . he's cool to the touch and floppy and sonorous, with junky lungs. Most likely thing around here is a convulsion that coincided with a major temperature spike from the release of malaria parasites, but he doesn't feel hot. I ask the mother if she sells alcohol. No. Could he have gotten into a stash, or taken any other drugs? No. But of course they weren't exactly watching. We bundle him into the treatment room, send labs, push dextrose, and put up drips for malaria. While I'm doing the lumbar puncture and the clear spinal fluid is dripping out of a needle in his back, dad remembers now that he found empty bags of alcohol at home . . this is strong stuff, vodka sold in plastic baggies. That explains a lot, but we can't afford NOT to treat malaria and pneumonia given his exam, until our labs come back. As I round, and look into each little face, I am reminded of how much children have to fend for themselves, how often they are left to their own devices. Tempting to gather them all in to my idea of safety, but I also see that they cling to their mothers (even to less- than-reliable ones). There are worse things than being ill, and being taken away from your mother must be one of them.
Roadblocks on the way home, with police. I hear someone calling on his cell phone to get help from his dad, it seems the police are confiscating all motorcycles without license tags (called number plates here). Which is most of them. The road is eerily quiet. I like it. Maybe they will find our stolen nutrition cycle. In the short ride home I'm called by the midwives who need help getting HIV test kits for antenatal clinic, and another staff who asks me to contact the water line fundi to turn the water back on for the health unit, and I get a message that our appointed doctor will not be around 4 or 5 days again this week. I try to be patient but mentally tally about 6 total clinical working days in Nyahuka in the six months of the contract . . . though many more I am sure at Bundibugyo hospital, or doing administrative tasks.
At home the blazing sun makes the laundry on the line smell like it has just been ironed, it is almost too hot to touch. The team is gathering for an afternoon nutrition meeting: we are hosting Stephanie Jilcott and Scott Ickes this week, as they follow-up on research they had begun while here. Soon our Ugandan extension workers (Pauline, Lammech, Baguma Charles) join us to discuss progress or lack thereof, what percentage of chickens are laying eggs and why, how we will improve home visit follow-up of malnourished kids.
Just as the meeting is beginning Ivan arrives to say that the CSB gatekeeper has told him the gate is closing on admissions . . . he must be accompanied by a parent to get in. I had intended to do this in the early morning, but Ivan was mis-informed by an administrator that the process BEGAN at 2 pm. Not wanting to be difficult I did not appeal based on my hospital and meeting schedule . . but now it turns out that the process ENDS at 2pm, and it is 2 pm. So I leave the meeting in progress and go through the newly organized and efficient admission process. Teachers at the gate inspect his trunk, criticizing him for having 3 casual-wear blue shirts (2 are required, so we thought 2 was minimum, but it seems they are treating it as a maximum). They make him remove one set. I recognize the entire process is meant to instill humility, to show off the bat who is boss, so I keep quiet. We sign in, confirm fees were paid, sign agreements to abide by the rules, get a meal card and dorm assignment. I like his dorm teacher, who was Jack's cell group leader last year, and I like the process of helping him carry his trunk down and seeing his bed. A half dozen other boys are in the dorm, and the boy in the next bed seems to know Ivan already. The shutters are closed and the room is dark and crowded, but livable. I shake Ivan's hand goodbye. Last year I got in the car and cried after leaving him in the miserable little unfinished brick primary school dorm. This year Ivan looks like he could cry, but he doesn't, and I think he's just nervous. We're both glad for him to be in Christ School. Back to the meeting, then back down to the gate to enroll my S5 student. It is my 5th time through the process so the teachers are beginning to expect me back . . . but this time it is less pleasant because the S5 deadline kind of crept up on us and my boy does not have all his requirements (only 1 graph book not three, only 1 belt not 2, etc.). So the teachers are harsh and I have to beg for grace. In the end though he is settled in a good dorm, a new one, with a staff member who was once a missionary-sponsored-kid in Ndyezika's class. A nice connection.
Back home in time to get my own kids snacks before they head down to sports practice . . knocks at the door, . . my neighbor with a headache and a covered appeal for moral support on her side of a family issue, the little brother of a good friend who is looking for help with school fees, a man who wants me to examine his wife because she's losing weight, a church leader who is caring for orphans and wants me to help one with shoes. Now, a debriefing respite between me and my computer which has done me good . . though I don't expect anyone but my mother and husband to read this far. Then I will go on to preparing dinner, chili, which requires tomato sauce made from actual tomatoes, beans, vegetable, corn bread made without a mix, that sort of thing which is tasty but time consuming.
The day will end with the peace of dusk, candlelight, community, food and shared life. It must be Monday.