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Wednesday, December 16, 2009

A decree went out . . .

Not from Caesar Augustus this time, but from the personnel office and the Chief Administrative Officer, that every health worker should report to the central offices to be counted and documented.  I suppose the disruption does not compare to that of Palestine two millennia ago, but in my narrow world it felt rather significant that EVERY HEALTH WORKER was to simultaneously leave his or her post and gather in one spot.  In some places an administration might consider the ongoing necessity of health care and worry about taking every nurse, every midwife, every lab tech, every person off duty district-wide for two days this week.  In fact they might consider leaving their office and traveling a few miles to count and document  personnel AT the hospital rather than calling the workers away.  But not in Bundibugyo.  Just like in Jesus' day, the powers-that-be make their declarations, and the small people have to sacrifice to comply.  Of course when we started making phone calls we were told that it was all an abrupt plan from above, that the district was powerless to stop it, that no one had been informed, that of course the workers could stagger their reporting or send representatives.  But by then the masses were not going to risk losing their perpetual pay-check, and EVERYONE decided to heed the call.  Everyone except our most senior staff member, the in-charge clinical officer, who dutifully rallied and stayed on site.  Biguwe is a good man.

Which is why I am particularly grateful for the student rescue.  Our med student Baluku Morris, two of my CSB students Birungi and Mutegheki, and my own personal student-son Luke, stepped in to save the day.  Particularly Luke and Mutegheki, who ran the HIV-nutrition program today.  I suppose since we were gone last week and next week is Christmas week, a month's worth of patients decided this was the day to come!  All four young men worked very hard, weighing babies, counting out eggs and beans and pills, writing in ledgers and charts, translating and organizing.  I think they got to see some science-in-real-life as we talked through cases, as well as get a sense of the hard work and important consequences of medical service.

And in the midst of frustrations with the poor planning, with the usual sadnesses and struggles, two outstanding moments of redemption today.  First, a chunky cute little six-month-old whose AIDS-patient mother wanted to save his life by weaning him, but only if he was actually not infected.  His blood screening results were not yet back, but some phone calls to the lab in Fort Portal actually worked, and we found out he was HIV-negative.  Unusually, both mother and father were present together, and their joy on hearing the news fortified me for the rest of the day.  And, to save the best for last, Masereka Jokim smiled.  This is a 9 month old who has been barely alive at 4 kg for several weeks, one of the most skeletal and scabby infants I've ever seen, held by his all-alone Congolese mother, inactive and whimpering.  Over the last few days he finally began to respond, to be hungry, to drink, to inch upward in weight.  Today he hit 4.5 kg, and as I examined him, he looked up and SMILED.  This is a monumental sign-post of hope.  

We can live through arbitrary decrees, absent staff,  and just about anything for a smile from Jokim.

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