Mulago Hospital

(Me holding Ronnies son, Don. To the right is some of the children that I gave some t-shirts to.)

I feel like it has been quite a while since I had the opportunity to update you guys! Things have gotten a little bit on the busier side since I started volunteering at Mulago Hospital! Where do I even start? I was in complete shock when I first entered Mulago Hospital; COMPLETELY overwhlemed! It is something out of the pioneer ages...Florence Nightingale would be in shock! I shall paint you guys a picture of the ward I have been working on so that you can somewhat share in the emotions I have been experiencing.

I started my experience on the pediatric special care unit. The patients on this unit are premies and infants in need of critical care. The special care unit is divided into three rooms. Group 1 is for the premies; they are all in incubators (or mostly), and they all are on oxygen of some sort. Group 2, in the middle room is full term infants found to have labored breathing or low APGAR scores. I have no really figured out what room 3 is for. It seems as though a couple of mothers are sleeping in there and there is one lone incubator with a baby against the wall. Why he is in there, I do not know.

(This is room two for group 2: the fullterm infants. All of the cribs are just crammed in together; maybe 20 or so total.)

Upon entering, there is a sign that states that you must leave your shoes outside. Mothers walk around the unit in their barefeet, whereas, nurses change into flip flops. They call this isolation precautions! I requested to bring my own shoes because one, I didn't want to walk around barefoot (you guys know I am a germaphobe), a two, what if a needle or something fell and went into my foot!?

(This is the supply cart for the "unit". Unlabeled syringes, gloves! (They do have gloves!), and the operating table on the left (yes, I said operating table)

The unit is complete chaos-there seems to be no order to the mess at all. The equipment is outdated, there are almost no supplies, and I am not sure the doctor knows what he is doing. There is one thermometer to the unit so the doctor has the responsiblity of taking vital signs, and there may be two stethoscopes. The nurses responsibility includes cleaning, inserting venous cannulas (there are no IVs), and giving meds. I have not figured out how they know what they are giving and whether or not it has already been given because nothing is labeled and documentation seems to be rarely done. There are just syringes lying around that you grab. All of the babies seem to receive the same three meds (D5W, Amoxicillin, and Gentomycin) so I guess mixing up the syringes wouldn't turn out to be the biggest problem. Needles are disposed of into a cardboard box with a hole cut into it. Watching a nurse put a cannula in made me cringe. There is absolutely nothing for pain, so you just kind of go at it. The first child I watched get a cannula placed took three attempts! And I pray to the Lord that the third actually went into the vein. I was trying to put D5W through a cannula and got obvious resistance - I told the nurse that the cannula needed to be re-done and she pushed anyways. The fluid exploded EVERYWHERE. I can't imagine how painful that could have been for the baby. The second child I went to give fluids to was so small. I was horrified when the nurse yanked the baby onto the door of the incubator to get to the cannula. I thought he was going to fall to the floor - such a fragile baby!

(This is room 1 for the premies. There are about 25 incubators crammed into this room. And the incubators are very outdated!)

Because the nurse to patio ratio is so poor, 1 to 50, the mother's provide the basic care. Every two hours the mother's come to breast feed their child. Most of the babies, because of a lack of patient care are covered in their own feces and urine. I wanted to clean a baby up only to be told by a nurse that it was the mother's job and that if I really wanted to do it, there were cotton balls. Cotton balls were pretty much the only cleaning supply avaliable. I tried to clean the baby with wipes I had in my bag. Infection rates can be really high for premies, and yet th ere seemed to be little regulation on the opening and closing of the incubator's doors. The O2 on the wall is an odd contraption with dozens of tubes feeding into one unit. Not really sure how that was rigged, but tape seems to be a big contributor. The nurses and doctors often dropped things on the floor, but that didn't seem to stop them from still using the items. Nurses didn't check air bubbles before giving medication and what really made chills run down my spine was the amount of tapping and banging that was done on the outside of the incubators.

(This baby was just plopped down on a table because they were out of incubators. I was terrified that he was going to roll onto the floor or something because he was so exposed!)

My last grand experience for the day was the infant who was barely breathing. It was pale, blue, and extremely cold in all of its extremities. You could feel a heartbeat but it was definitely not enough to circulate O2 and blood to his body. The nurse would come over and give a couple of breaths and then walk away saying, "I just can't get him to breathe" like it was no big deal. I told her I would help with CPR, but that is a very loose term. CPR means 3 compressions followed by a varying number of breaths. After about 20 minutes, the doctor finally came and was able to bring the neonate back to life. But after all that time I kept wondering if the baby would have massive brain damage.

I know the last couple of paragraphs have been terribly negative and sound so awful, but it gives a better understanding of what I saw and how I felt. I really left without seeing any hope in that place. If a baby does make it out of group 1 then it beyond me; completely by the grace of God. I kept thinking to myself, is it wrong to wish that these babies would just die? Because then at least they would be done being put through all the pain and suffering and could join God in a much better place.

I know there is a reason God has placed me in Kampala and at Mulago Hospital, but I am truly struggling to see hope in this situation, to see how to help anything to move forward and improve. I feel lost and truly helpless - like there is nothing I can do. But I know I must be positive and have faith that there is a reason I was put here. Another nursing student told me that at the end of the day, no matter how hard, lift your chin and know that you did something, did make a difference. Even if it comes down to providing love and compassion to an infant - you can never do too much of that!

My instructor was telling me that what needs to change is the attitude. At funerals they say "Praise the Lord for he is with Jesus now. This young child needed to be with the Lord." We say "How tragic! Why did the Lord take him at such a young age?" They need to question what is wrong and actually get mad enough to change it. Right now, their attitudes is a defense mechanism for all of the pain and suffering and loss happening right now.

On a lighter note, I am starting work at Baby Watoto on Monday! I am super excited about that. I will be volunteering on Monday and Wednesdays so I will let you guys know how that goes next time I get a chance on a computer!

My free time has been spent roaming the streets with Ronnie around Kampala. I kept questioning myself, asking God where the hope was in Kampala and I have found it in my journeys with Ronnie, in the children. The children are so happy, so untouched by corruption, not focused on money. They are pure and full of joy. They are able to laugh, to play, to make the best of the situation. I see God in these moments. When I am just sitting, meeting people, getting to know the people of Kampala.

(These are children living in Kisenyi! They were dancing to the music coming from the local church! They just kept laughing and having so much fun. It is amazing to me how much joy they have despite their living conditions.)

Yesterday, Ronnie and I returned to Bukoto to give the pictures I developed to the grandmother and her three grandchildren. She was so happy! She said I was truly a friend of the family because I had kept my promise! I wish I could speak to her directly, but her facial expressions and body language were enough. I told her I would come back to say goodbye before heading to Kenya.

(This is one of the grandchildren of the family Ronnie and I met in Bukoto. The first time we visited, the youngest daughter was terrified of me. (She had never seen a white person before). This time we got to the point where she would touch my hands, to see how I feel; if I am the same as her.)

I also was able to visit Ronnie's community and meet his beautiful 2 year old son, Don. Ronnie lives in a one room house, divided in half into the bedroom and the rest of the home by a curtain. The room is no bigger than two mattresses lying side by side. On one side is a mattress shared by Ronnie and his eight month pregnant sister, Grace, and a crib for his son. On the other side are pots and pans that mark a kitchen and a chair for a den. Ronnie chose to live there because he didn't want his son to be corrupted by the slums. I couldn't imagine having to live in such a small space. It would feel like being imprisoned everyday, but that is what Ronnie and his family have.

(This is Ronnie and his son Don. Isn't he beautiful!?)

(These are some of the children that I gave shirts to in Ronnie's community. I have to say I am a little proud of the fact that there are now children in Kampala running around showing off UNC's colors!)

After visiting Ronnie's community, we went to Kisenyi or the slums. I don't even know where to start except to say that no one should have to live lie that. Dumping grounds are everywhere, sewage water runs freely, and what is worse, is children are forced to play next to it, and mother's are forced to cook by it. And that there is so much joy in the children! The local church was having rehearsal for service on Sunday and everyone was dancing and singing! THAT is how I believe God intended us to praise and worship Him; with dance, and song, and passion! Not with schedules and lists!

(A typical home in Kisenyi or the slums)

(A girl being bathed outside by another child in the slums.)

Ronnie and I talked about the possibility of me returning one day to set up my own clinic! I kept thinking how amazing that would be, and then if my mom and sister could come back and work as nurses for a little bit! To experience my passion! But I would definitely have to work in America for a while to develop my skills because right now I really do feel helpless. It could be affordable, up-to-date healthcare!

So where am I at this point? I continue to wander the city! To take it all in, meet its people, learn about its culture, and hopefully stay together in one piece! I have grown to LOVE matoke (a local food made of plantains), and the pumpkins here are AMAZING! I am pretty sure I am going to go through pumpkin withdrawal when I return home. The city is overwhelming, yes, and sometimes can beat me down and take my energy. But it is in the moments that I get to sit and talk with people that I am reminded why I am here and that God really is present here.

(A group of people Ronnie and I sat and talked with for an hour or so at a small local store. They were so much fun!)

I am hoping to get out of the city in the next couple of weeks because I need a break! Pray that I continue staying positive and compassionate! And that my energy never fails me!

I miss all of you! Much love from Uganda!

"Let us not grow weary of doing good, for in due season we will reap, if we do not give up!" Galatians 6:9

It is often what we see that shocks us that causes us to institute change.