Push vs. Passivity

Much of life as a missionary and a physician in a rural, poor, marginal, and probably corrupt place involves PUSH.  By this I mean the extra effort required to make the system work the way it should.  One could simply go the hospital, do what one can do, and throw up one's hands about the rest.  Which is, after MANY YEARS of stress and defeat, the passive way that many of our colleagues cope.  And me too, some days.  

But not today.  As soon as I walked on the ward I found out that my newest admission had died at 2 am.  This was an extremely ill child with sickle cell disease and severe acute malnutrition, who had come on death's doorstep.  Worrisome, but we've seen many similar kids revive.  Only this time, the person who promised to bring the blood needed for transfusion never showed up, and no one noticed or did anything about it.  I called him today, and he said the district had refused to pay for his transport, because all their funds were frozen due to failure of our entire district to pay taxes for who-knows-how-many years (and who-knows where that money went).  This is not a new problem, and this lack of essential funds does not seem to have kept half the district health office from traveling to a seminar in another part of Uganda today.  Meanwhile the blood transport question was tied up with the propane gas cylinders that we have advocated for for the last month, which run the cold chain which stores vaccines which run the entire country's immunization system, which have been out of supply.  Finally they were delivered to Bundibugyo town over the weekend (after their own set of phone calls last week).  Just 12 more km to make it to the health center, but this required desperate pleading and phone calls to a half dozen people to accomplish.  In fact I just counted 7 calls and 9 sms's from this morning, the cost of getting those in power to agree to release a vehicle and fuel to bring the gas cylinders, plus personal contact with the lab and a person with a motorcycle and provision of fuel from my own pocket allowed the blood-cool-box to go and get blood and bring it back for the next four patients with dangerously life-threatening anemia.  Though all this should happen automatically, it DOES NOT.  The people affected do not cry out, they accept their inevitable problems.  And those who have some ability to make a difference are either overwhelmed by too many other issues, or profiting from the diversion of funds, or caught up in the same passivity.  

Mid-morning I realized that a neighbor's baby I'd seen early at my house never showed up for a lab test as directed.  Again, phone messages to the child's grandparents whom I know, pushing.  An hour later, they are there, and the child turns out to have severe malaria, AND sickle cell disease, AND need a blood transfusion.  The ward is not so busy, but still I spend half the morning finding the person with the key to get a patient the food they need for discharge, or leading someone by the hand to get their TB meds refilled after they defaulted, or encouraging an aunt to offer her newly-orphaned nephew her own abundant breast milk as the tiny infant screams in hunger, refuses spoons of boxed milk, but eagerly sucks her breast and falls into an exhausted sleep.  

Then "little-miss-polka-dots" shows up with her mother, my true hero of persistence, the antithesis of passivity.  The mom is convinced that we needed to file yet one more form with the police, or check on the "file" one more time.  More phone calls, the police confirm that the rapist whom we caught has been moved to a more secure jail in Fort Portal.  We discuss Miss Polka-dots' mental/emotional recovery, give candy and paper and crayons, unheard-of luxuries, and make sure she's in school.  Mom leaves, relieved.

The child I THOUGHT would die lives on, Ivan Tumwine, miraculously SITTING UP after a litre of IV fluid revives him, non-passive effort by Assusi.  Little five-year-old Kabasa has turned a corner, he smiles and runs after a ball, new appetite kicking in on his second week of TB therapy, and the possibility of healing dares us to hope.  Twins, and a one-year old girl whose mother had abandoned her but was convinced to return when she ended up malnourished, all go home today, cured.  Nathan discharges from the motherless program the very first new orphan he personally enrolled a year ago, healthy and alive.  New premature twins arrive, bringing our 2-to-3 pound speck-of-a-baby population up to 4 on the ward, too many for the side isolation room, so we cordon off an entire section of the ward after cleaning it well, and try to make it a safe preemie environment.

Very little of my effort today involved specific medical knowledge.  Very much of it involved a few resources that most people do not have:  about 4 dollars of air time, about 4 dollars of petrol, and the sense of outrage that growing up in a country that generally "works" lends to my perspective.  People who work in settings like this need prayer support, to not give up, to believe that a little more push is worth it.  I know I do.