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Saturday, December 07, 2019

Hope, the elusive door in a dreary world

Hope, the theme of Advent this week. We hope for what we don’t see, and yet every day the not-seeing-yet just feels like a mire.

Just one day of examples, here’s Friday. No major tragedies, just the slog.







Friday mornings start with staff CME (continuing medical education) at the hospital, and our newly minted doctor Isaiah is presenting. People trickle in, the computer doesn’t work at first, the usual glitches adding up to about a 45 minute delay, but he has a well organized presentation and an active teaching style.  I’m proud of him, but I only get to hear the first 15 minutes or so before our nutrition team, whom I have given a ride to, calls me back to the ward, saying there is a really sick patient. Since there is no real system of vital signs, handover, or emergency response, it is not until they walk onto the ward to weigh people that the little 8 year old in the first bed who is writhing in delirium attracts any notice.

I hurry over from the CME building to the ward, and find the night nurse miraculously still present, When I ask who is sick he’s aware that it is this patient but has no information about her, and has not evaluated her in any way. So it takes me a while to piece together from the family and her scribbled exercise book which is a medical record that she does NOT have cerebral malaria . . . In fact she has sickle cell disease and a cough and when I take vitals her oxygen saturation’s are in the 70’s and her lungs are full of pneumonia. She’s right next to one of our two oxygen cylinders (thanks to Dr. Marc’s project) because she’s next to another boy with acute chest syndrome from sickle cell, so I take the oxygen and put it on her, and it’s amazing.  She calms immediately.  She was writhing from a sense of suffocation, and now she relaxes into breathe-ability.  Her dad tells me, she was on oxygen part of the night but the nurse removed it.  I ask the nurse why, and he says, she had been on it too long. Because of the scant nature of oxygen supplies, they tend to parse it out and as soon as my back is turned they turn it off.  Deep breath for ME and patiently try to explain to him and the day duty nurse that we must monitor patients and not just stop oxygen based on time, but on a patient’s improving response. But now we have no oxygen for the other boy, whose saturation’s are 80% (up from 60’s), which means calling the med sup to replace an empty tank which had ironically been left on with no patient attached while they turned off the one for the girl who needed it . . . And when that arrives, finding the small wrench (spanner) that allows changing regulators and opening it.  And climbing up on a table myself to open the replaced tank. And so it goes. Nothing is as simple as simply writing a dose or ordering a lab. We diagnosed TB by taking a gastric aspirate gene expert sample two days ago, but . . . The mom didn’t understand she had to walk over the TB clinic to get the meds, and the nurse just injected ampicillin and moved on. This toddler is actually a defaulter on therapy.  I diagnosed her previously this year, but when her mom had a baby three months ago it was too hard to come back to the hospital and her toddler was better so they quit. And it seems the grandfather is probably coughing out TB at home and reinfecting everyone, but refusing to come in, so I told them they can’t be discharged home until he comes. They seemed to get it. The second-sickest (per the early call) was a 12 year old boy unconscious after a shotgun of anti-psychotics and seizure meds (not making this up, 5 different meds) were injected in him overnight. The “mental health” nurse is on leave, but he thankfully takes my call and COMES IN ANYWAY for which I am deeply grateful. He actually talks to the family and finds out that the boy’s father died and this month the uncles took back the land and house he and his mom had inherited, and tore the house down, leaving them homeless. We narrow down to one antidepressant and counseling, but what he really needs is justice.


And so it goes, about every three patients on the packed ward I get pulled to this issue or that crisis, and it takes me five hours to make it to every bed, alone. I know my attention and patience are wearing thin. There are some bright spots. I take a moment to rejoice in two children who had been ones I thought would die, they came in barely alive from cerebral malaria and both were going home.  One was malnourished too, and still needs nutrition follow up, and the other will see the physical therapist for some residual weakness, but they are 90% back to normal and alive. A couple of parents also express thanks. Resurrection is beautiful. But there is little time to be happy about that handful when there are so many with high fevers, pale eyes, swollen limbs, listless attitudes. A young lady who grew up with our kids comes in with her jaundiced two month old, and I am deeply concerned. By the time I get to the very last patient, Dr. Isaiah has popped back over but is immediately sucked back into other work. I see a malaria patient ready for discharge, and her mom then thrusts a book into my face for another infant. I really want to say NO I’m only seeing the admitted patients . . But I dutifully take a look and it turns out to be the 5 month old baby of this lady’s sister, who died 4 days ago.  The baby is malnourished and obviously needs to stay. Sigh.  It’s now about 2:30 as I drive home, rushing to make it to an afternoon meeting.



The meeting is for our little Rwenzori Mission School PTA. For the first time in our history, we had no missionary kid teacher to start the year this year, so the two families (7 kids in grades K/1, 3, and 5 ) have been collaboratively homeschooling, meaning they have to pull back from other ministry and also juggle their two younger-than-school-age kids too. They have risen to the challenge, but we’re all thankful that Lindsey Knapp arrived like Mary Poppins with practical service and kid-oriented grace and enthusiasm.  But even Mary Poppins would find all 7 and 4 grades a bit much for one teacher, so we’re working out a delicate transition of some parents doing less and Lindsey moving into more. Anna is our PTA chair and school advisor so that helps a lot, and everyone is kind and honest and willing and tired. Precious things are on the line, the good of kids who had no choice in the move to Uganda, and the friendships of families and cohesion of community. It’s a good meeting and we have a solid way forward, but we NEED MORE TEACHERS. Again, the reality of hope is that you only experience it when things are NOT OK and you are waiting. But how long??

It’s pouring rain. The power company worked on the mission transformer and everyone else has power, but we don’t. Two of our kids had minor car accidents this week on the same day, no one hurt, but it does raise fear on one’s heart. I miss them. My computer died a month ago so all my work has to be done on a phone, which is tedious. It’s Christmas cookie season and I don’t have the ingredients. It’s sometimes just the little things that drag my heart down.

So hope, that elusive entity. We march on and acknowledge that all of the above is, in the big picture, kind of a whine. We are alive and dry in a comfortable house and so many people we know and love are not. But that’s missionary life too, the guilt of even saying one’s day felt long and hard.

For Advent, we want candlelight and community, warmth and expectation of all shall be well.  And it is that. But it is that in the context of a lot of dreary reality, of broken wires and parasitic muck and human cruelty and powerless longing. Come, Lord Jesus. 

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