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Saturday, July 28, 2007

The Sword of the Siimu

Reading the passage in Ephesians 5 about the armor of God with the staff yesterday, we talked about how a UPDF soldier is equipped for the battle against flesh and blood, and how our battle is not against flesh and blood but principalities and power and forces of evil . . . Which sounds very reasonable in Africa and a bit on the edge of creepy in America, but the fact is that distinction helps me avoid the dehumanizing pressure to see those who obstruct my plans as enemies.

Take the case of Paulo.  This little boy showed up on the bench outside the old Peds ward in early July, referred to me.  I thumbed through is well worn kitabo (exercise book) and saw that his persistent mother had taken him to various health centers, more than a dozen visits in his three short years of life.  In most he complained of painful urination, and was prescribed antibiotics.  He had some abdominal tenderness on exam but otherwise looked like a normal healthy preschooler.  I started asking questions and formed a pretty good guess that his problem was posterior urethral valves, a congenital blockage of the urine stream, which eventually leads to increased pressure all the way back to the kidneys and destruction of kidney tissue.  His urinalysis was a mess, and Scott did an ultrasound that confirmed the impact on his kidneys was already significant.  He needed surgery, three years ago, but at least as soon as possible.

There are only two options for specialty care:  the massive public referral hospital for all of Uganda called Mulago in Kampala, or finding a private/mission hospital with a surgeon.  I had a phone number for one urologist at Mulago, and he instructed me to send him for his colleague to see.  The only private option, International Hospital, has limited charity surgical beds and told me they were full.  I know Mulago is a terribly difficult place, but if he did not get surgery his life would not be very long, and the time he had would be increasingly uncomfortable.  So I sent them off with transport money, pocket money, and prayer, two parents and a little boy who had never been out of Bundibugyo before bravely navigating the big city.  

So began their Kafka-esque weeks of futility, languishing in the decaying and over-crowded hospital.  The place is desperate, and ill-equipped and under-staffed.  Care is supposed to be free, except for the fact that nothing functions and there are no supplies, so patients are routinely sent out to private clinics and pharmacies to buy anything from a few pills of tylenol to gloves for the surgeon.  Paulo’s father spent a precious few coins calling me on the phone in pressured Lubwisi, I could tell he was out of money but had no way to reach him.  Then he sent his wife back to explain that the surgeon would not operate without a radiologic study of Paulo’s urinary system (a reasonable test) but they needed 80,000/= (about $50 or a typical month’s wages here) to have the test done privately.  I was caught in my typical gamble, a little more money could make all we’ve spent so far pay off . . . So I complied.  Then a few days later the desperate phone call again.

This time I’d had enough, it was three weeks since I had sent them and they seemed no closer to definitive help.  The sword of the siimu came out—cell phones are called “siimu” after the sim card.  I burned up the airtime trying to contact the patient and the doctors.  About two hours and a half dozen phone calls later I had convinced the admitting doctor at the International Hospital to accept him in transfer from Mulago and arrange for surgery.  This hospital was started by an Irish missionary doctor who finished his mission service, survived cancer, then returned to Uganda to found a hospital with higher quality medical care for paying patients.  It truly fills a need (including emergency surgeries for two or our kids in the past few years!!).  Recently they convinced some businesses to support a “Hope Ward”, free care for indigent pediatric patients.  They have to be referred and accepted, but this is the third kid I’ve sent this year.

Now the real twists:  the private urologist who agreed to do his surgery at International Hospital (paid for by this charity) turns out to be the head of the same group of physicians who had not managed to give him care at Mulago over the last three weeks.  Injustice?  Or just reality?  And to make matters worse, the only way I had to contact the patient with the good news that he could move to International was through these doctors, who immediately began to make excuses that the surgery would be done at Mulago right away, as they realized how iffy the whole thing looked, transferring their patient from public to private.

It’s a long story, and not over yet.  Paulo’s mother showed up again this morning with his radiologic results at last.  Diagnosis:  posterior urethral valves.  Same thing we suggested three weeks ago.  She was told that surgery could not be done until they managed to obtain a urinary catheter.  So she spent two days and another chunk of money coming back to find me.  I wrote a letter to transfer Paulo and gave her instructions and money and sent her back yet again.

Headlines in the national newspaper today decry the tragic state of medical care at Mulago:  60-70 deliveries a day, 15-20 needed C sections, average 5-6 infant deaths/day among those deliveries, women crying in pain on the floor of the overtaxed unit, 3 staff on the roster per shift to care for all those patients.  Now who is the enemy?  The doctor who drags his feet at Mulago but jumps at the chance to operate at International?  Though I was angry about this injustice, today I have more perspective.  Those doctors are working in a hospital built 40 years or more ago, when the country’s population was probably a quarter of what it is now.  They are struggling to make do with little funding, inconsistent supplies, and a never-ending onslaught of referrals, the last resort of a crumbling medical system.  Last night Scott helped Jonah on their 4th emergency C section here in Nyahuka this week—nothing like the Mulago rate, but frankly beyond what this little theatre can handle in terms of supplies.  Who is the enemy?  Not flesh and blood, not desperate patients, not tired staff.  The evil is so much bigger than that, the sickness that came into our fallen world, the greed and injustice that diverts money from the needy, the disparity between what is available in America and Uganda, the apathy that allows patients like Paulo to go years without a simple but life-saving procedure.

So we are called to fight back, even if it is will a cell phone, we take satisfaction in the one little reversal of injustice that Paulo represents.

1 comment:

Anonymous said...

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