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Tuesday, September 22, 2009

One step forward, two steps back...

Occasionally, the stars align...and the health care system in Bundibugyo works.

Today, I (Scott) received a call from Jennifer who relayed a request from the chief midwife at Nyahuka Health Center that they needed an urgent ultrasound, because they could not hear the fetal heartbeat of a mother in labor. I biked down with my trusty SonoSite 180 in my backpack, the noonday sun blistering hot. In the delivery room, I began to unpack my ultrasound while the tiny mother began to climb onto a step stool to get on the delivery table. Ker-splash. At least a liter of bright red blood splashed out between her legs onto the white tile floor. Yikes. She began to scream and cry. There's really not many possibilities medically speaking here. The placenta has separated from the uterine lining before the baby is born (placental abruption). I quickly got her onto the bed and confirmed with my scanner that the baby was indeed dead and that the placenta had indeed separated.

The midwife mobilized the family who mobilized a pick-up truck. I called the medical superintendent of the hospital who prepared the surgical theater. So, she was loaded into the back of a truck and rushed over 8 miles of the worst road in Uganda to the District Hospital. Within an hour, she had a Cesarean delivery and her life was saved. She could have very, very easily bled to death.

Not every anecdote from Nyahuka is so happy. Amon Bwambale, our clinical officer from Nyahuka who is now studying medicine at Kampala International University is on break between first and second year and returned to work (!) this week. He joined us for dinner this evening and during dinner we went around the table sharing "highs and lows" of the day. Amon described how frustrating it has been this week to see patients, diagnosing and prescribing, but the cupboards of the health center are empty of drugs for outpatients (note: World Harvest funds the drugs and supplies for pediatric inpatients only). Outpatients are instructed to go to the private clinics and purchase the drugs which have been prescribed in NHC Outpatient Clinic. The reality is that most patients proceed to purchase one or two capsules of an antibiotic or antimalarial, an inadequate approach to nearly any infectious disease. Many of them return to outpatient in worse condition than when they were initially seen.


Paul Miller in his book A Praying LIfe reminds us that "God wants us to come to him empty-handed, weary, and heavy-laden." (p.54). I think we qualify. Let's go.

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