#COVID-19UGANDA day 36, Easter day 14: When prosaic steadfastness becomes global poetry

Perks of being the last person to finish work: On Friday, the whole team ended up finishing ward rounds with me. We had to capture the moment because 4 doctors, a dietician, a nurse, and an assistant all in one spot represents such a significant percentage of active medical care in the district for a morning it was remarkable. In my defense, my first four patients of the morning were all ICU-eligible, only we don't have an ICU, we have three tables in the front of the room near the outlets for the oxygen concentrator and the window into the nursing station and with poles to hang blood transfusions. The first was actively convulsing from cerebral malaria. The second had a respiratory rate of 110. The third was a listless girl with sickle cell anemia unable to be transfused because the blood bank was out of her type. And the fourth was an infant with oxygen saturations ranging from the high 60's to the mid 80's as he struggled to breast feed.

Our "ICU"

New admission with malaria and decreased level of consciousness, quick check that she wasn't about to expire from anemia .

After that there were the usual kids draining pus and sweating fevers, dwindling with diarrhea, suspected of TB, with unexplained jaundice or persistent vomiting. Scott had planned to deliver triplets by C-section he discovered when doing an OB ultrasound this week, but that case had to be bumped back to Monday so the operating theatre could rescue a woman in urgent need of a C-section for obstructed labor, another with an ectopic (tubal) pregnancy, a man with a perforated bowel. Drs. Marc and Isaiah were introducing our new flow sheet for feeds and fluids and antibiotics in the NICU, and Jessie was weighing every patient and starting the most malnourished on supplemental milk or ground nut/soy paste. 

Into all that mess, the prosaic and unremarkable work of steadfast, quotidian, routine care.  Dextrose and diazepam and an LP, drawing blood for hemoglobins and crossmatching for transfusions, calculating feeds and fluids, instructing parents about what medications should be given at what time (nurses are overwhelmed, so parents have to initiate), reviewing wounds, changing dressings, doing ultrasounds, listening to hearts, checking pulses, probing abdomens, connecting oxygen, listening to concerns and giving reassurance. There is nothing very high tech or very remarkable in any of this. It is very basic medical care. We have no fancy monitoring systems, no ventilators, very limited drugs. But we take what we have like the epitome-of-prosaic loaves and fishes, and hand it out. 

Of course, after prayer. The morning staff meeting with our distance outdoors always ends with prayer.

Our kids sent me a link to a Peter Cottontale -Chance the Rapper song called "pray for real" that has stayed in my head. I pray for vision, I pray for wisdom, I pray for weapons against the system, I pray for freedom to free the victims, to heal the brain, no pain inflict'em, I pray for real, I pray for real, I talk to God then wait for real, can't fake the fall, can't fake the feel, I pray for fun, I pray for real, I pray for ya'll . . . Prayer is part of that prosaic steadfastness. After the staff meeting I always start rounds with prayer. I mostly say the same thing, every time. I ask God to come and heal the children because God can, and we cannot.

For five weeks and counting we have been living a severely restricted state, watching the world-wide pandemic escalate, reading all the news and medical literature with dread. But more and more, it seems that the basics are what we need. Africa has much to offer the world on grit. We can isolate, we can screen, we have brave ambulance drivers and medical officers, we can wear masks and wash our hands, we can be humanly present to comfort, we can try to keep up with oxygen and blood, we can trace contacts and make reports. We can develop a sense of shared community in the effort, we can put the present troubles into a bigger universe of spiritual perspective. We can determine not to neglect the real killers, malaria and TB and complicated labor, hypertension and diabetes. We can be mundane and plodding but still walk through the valley of the shadow of death.

This quiet nurse Amos fills out the discharge forms and gives pills and instructions to the parents every day, unglorious but essential work.

Olupah is our charge nurse, and she gets things done!

And down the road, CSB staff are working on our second packet of homework for students. With care to spacing, with obedience to limited transport, but with that same commitment to the small tasks that add up to service. 

And our RMS teachers are in the final weeks of the year's curriculum. Moms still make meals, draw baths, monitor conflicts. Our accountant John is plugging away at his spread sheets. Josh got permission to begin essential work on the Nyahururu water project, at the epicenter of the December landslides, one of the systems that was completely destroyed. His truck of pipes was allowed to pass from Kampala yesterday, and today's he's up at the site directing the first steps after months of planning. Neighbors stop at the gate, sit on the porch, bring news that Bundibugyo's government salaries will not be paid in April affecting all the teachers, health workers, etc. Electricity is intermittent, lines being repaired. Uganda has two other plagues at the moment, a swarm of locusts larger than any in decades landing on crops in the north and east; and rampant water hyacinth islands blocking the Nile's power generating dam.  Prices for cocoa, our main cash crop, have dropped. But we see lots of people with hoes and pangas, trooping off to gardens, and right now plot after plot with the early grassy green shoots of rice. Ramadan began yesterday, and even though curfew and COVID have stopped the blaring music at night we could hear our neighbors in their compound celebrating their iftar meal. Life going on, people adapting, and the heartbeat of all of that is the common daily inglorious work that is the core of what we do.

The very nature of the simplicity and tedious-ness is part of what connects us all. I learned a new word on an Africa-CDC COVID-19 webinar this week: concatenation. The chain that links us together. Day after day, week after week, we begin to hit the wall where the adrenaline of crisis has ebbed and the draining work of stepping into each new day continues. But as we do that, we are not alone. We are linked. 

  

And perhaps by doing that, day after day, the prosaic takes the shape of the poetic. Psalms. Praying for real.