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Tuesday, September 22, 2009

snapshots of a day

Three hundred chicks, in a mud-walled and screened shelter, Jack helping our agricultural extension workers under John's supervision to vaccinate them all, the future of egg-protein for malnourished kids.  Dusk falling, the charcoal glowing in small screened towers to keep the chicks warm.  Three weeks old and so far 100% survival.  No small miracle.

The two widows of my late neighbor, knocking in the afternoon, we sit on the porch, they reminisce and we all shake our heads to realize that their son John and my son Luke will finish high school this coming year, when it seems they were just playing trucks in the sandpile together.  They ask for ibuprofen for their aching backs, but I know the visit is not about the ibuprofen, it is just a check to be sure we're still in relationship.  My heart aches for the way their husband's clan disinherited them, and how hard they have to work now to survive.

Another knock, on the hospital store room door as I'm getting on my doctor-coat and preparing to begin the day.  A father holds a bundled child, having just arrived from who-know-where, and says the child is very ill.  As they all do.  But I tell him to lay the child down on a bed and begin to examine him.  The hot little body is too still.  No heart rate, no respiratory effort, vacant eyes.  He died sometime along the way.  I tell the father, who quickly re-wraps the body to walk back to wherever he came from.

Blue suede shoes, Israeli Birkentsock-type sandals, appear on a patient's dad.  Unusual, not just because of the style choice, but because the very same shoes were stolen from Heidi's house months ago.  I confront the man, who assures us he bought them in the Mpanga market in Fort Portal (3 hours away by car, who knows how much time it took the thief to unload them there).  Heidi wisely decides that she does not particularly want them back off this man's none-too-clean feet.  We laugh.

Greens, dark for the mountain tops, bright for the trees, a palette of shades for the landscape, as Pat works on her mural covering one whole wall of the Paeds ward, a touch of color and beauty and entertainment for some very sick kids.

Guvena Yona, the name on the immunization card, of a 3 year old admitted over the weekend, a child from our own village whose parents I know . . then I remember that he was called "Governor" after his political ancestry, but "Yona" because his birth was the late Dr. Jonah's first C-section when he was posted to Nyahuka Health Center.  Dr. Jonah saved his life, and his mother's life, but lost his own.

Chocolate zuccini cake, my mother-in-law's recipe, for no big reason.  We had zuccini from Kampala, and a precious can of cream cheese frosting from our summer of visitors.  So an hour of stirring and grating and mixing and baking, in honor of my family.  

Hands slapping, we play Speed Uno (taught to us by Lydia Herron years ago), which is hands down (ha) the best cross-cultural game ever.  My CSB/hospital mixer attempt for four young staff who are far from home turns out to be a lot of fun, laughing about how each was shocked how FAR away Bundibugyo is, sharing stories from our days and prayer requests.

The good news that Caleb's arm has healed enough to remove the plaster cast!  He calls from the hospital, cleared to resume full football privileges wearing only a splint.  We rejoice.

A moaning woman and a pool of blood, the midwives ask me to call Scott, who brings down the portable ultrasound and diagnoses a placental abruption and a dead baby . . . but still in time to save the mother's life.  Scott calls the surgeon in Bundibugyo town and we help arrange her transfer.  A few hours later we learn that the fetus was removed by C-section and the mother is recovering well.

A soberly distressed nurse tells me that a doctor from Kampala has arrived and wants to see me.  I am called into an office like a mis-behaving school child, as the imposing man chides me.  Why have we started so many children on anti-TB therapy?  I guess our disproportionate numbers got noticed all the way up the chain and he was dispatched to bring us in line.  Just then Kagadisa shows up for a medicine refill.  I call him in, and show his records, how this child was dying and now is alive and thriving.  And I begin to explain why we suspect the diagnosis on so many kids, though we aren't always right, we see lots of response to treatment.  So just possibly it is not Nyahuka that is OVER treating, but the rest of the country that is UNDER treating.  What starts as a hostile lecture ends as an interested and collegial discussion of TB diagnosis, and as he departs, the official doctor promises to come back and study this further.  Amazing.

Another day in Bundi, snapshots of sorrow and tastes of victory.  And cream cheese frosting.


Michelle said...

I always think of you when I am in the store and see cream cheese frosting. I also think of Scott and Carrot cake. Good to read about the people there today. Please say hi to Mukidi's wives for me. Can't believe John and Luke are that old now!


Charlotte said...

I follow your blog regularly and am working on several TB projects. Since we have so few tools to properly diagnose TB among children (and there is this perception that since they aren't likely contagious, they aren't a priority), I am glad that you had this conversation with the doctor. I really believe that underdetection, not overtreatment, is the problem. Keep up the good work! You and your team are such an inspiration!

Heather Pike Agnello said...

Yeah for cream cheese frosting, and for you.