reflection

The weekend provides a bit more time for reflection, reading and processing of the time here.  One of the books I am reading is called, "When Helping Hurts, How to Alleviate Poverty Without Hurting the Poor and Yourself"  by Corbett and Fikkert.  I am finding it very helpful and personally challenging.  Near the beginning of the book the authors challenge the reader to consider their motivations for helping the poor.

Here's a quote - "Development practitioner Jayakumar Christian argues that the economically rich often have "god-complexes", a subtle and unconscious sense of superiority in which they believe that they have achieved their wealth through their own efforts and that they have been anointed to decide what is best for low-income people, whom they view as inferior to themselves.


Few of us are conscious of having a god-complex, which is part of the problem. Consider this: why do you want to help the poor?  What truly motivates you?  Do you really love poor people and want to serve them?  Or do you have other motives?  I confess to you that part of what motivates me to help the poor is my felt need to accomplish something worthwhile with my life, to be a person of significance, to feel like I have pursued a noble cause... to be a bit like God.  It makes me feel good to use my training in economics (medicine) to "save" poor people.  And in the process, I sometimes unintentionally reduce poor people to objects that I use to fulfill my own need to accomplish something."


This is certainly causing some self evaluation...  and hopefully a more humble approach to my efforts in improving healthcare here.  It is easy to "teach" and tell people how it should be done, or how we do it in the US, or what the research shows...  and while there is certainly a place for sharing knowledge, the "HOW" it is done is crucial.

After reading later sections of the book, I have re-designed my approach for a meeting with the hospice nurses aides this week.  I was going to teach them about pain assessment, charting tools, etc.  to help them improve the quality of the care that the hospice patients are receiving.  After more reading and reflection today, I am going to start the meeting asking them each what things that they do well as nurses aides/people - what talents do they have?  Then I am going to ask them what they like about the hospice...  then what they don't like or what we could do better.  Would they like to be patients here if they were very ill?  What would they change?  Hopefully, this will prompt them to come up with the gaps  (ie.  not asking about pain everyday)  and maybe a few more things that I have not noticed.

Anyway - it has been a good weekend.  It is Ugandan Independence Day today, so tomorrow is a national holiday.  We will be working in the clinic and hospice anyway, but maybe the work will be light.  Baby David is coming back from the hospital tomorrow, so it will be good to check him out, see his wound, etc.  I saw his adopted "dad" at church today and he reported that David is improving.

I am very much enjoying Andrew Wright, the Australian physician who is leading the efforts here in the clinic development.  I think we complement each other well - he is soft-spoken, thoughtful and has a great sense of humor.  I am the bull in the china shop, often apologizing for being too energetic or opinionated.... oh well, hopefully I am learning.

The rhythm of the day

I thought it might be interesting to hear what events "mark" the day here in Kitgum, Uganda...

At around 4:30 am, the roosters start to crow...  it is dark outside and I check my watch and think, "really, 4:30 am?"  I put the pillow over my head and try to go back to sleep.  Eventually the sunshine breaks in and the noise level continues to rise.  I start to open my eyes when the singing starts.  Kids singing on their way to school, cooks singing as they pump water - the morning is here.

I fill my wash basin with water and go into the outdoor shower/bathroom.  Washing up and washing hair by pouring cups of cool water over my head.  A night shower is even better under the African stars  :)  Bathing twice a day is absolutely necessary because of the heat and dust - I am grimy at the end of the day.

Anyway - I also wash some clothes in the washbasin each morning and hang them out to dry.  Breakfast of porridge or toast. bananas, and tea - and a talk about what is on for the day.  By the time I gather my things to head to the clinic or the hospice, most of the 3,000 kids are in classrooms.  I can hear them repeating the teacher or the occasional giggle as I walk by.  The vocational students (high school age kids in training for building, sewing, secretarial, mechanics, etc.)  are all gathering outside and singing and clapping to start their day as well.  Wow, does that start the day off on the right foot!

We meet back around 1 pm for a lunch - which is usually rice, beans and some meat stew.  We had chicken today at lunch and I crunched down on neck and other unidentified bones  - so one has to be careful!    See Frances, the cook, below plucking our lunch.  May I add that the smell of the burning feathers does not stimulate the appetite in the morning (we were eating breakfast while he was doing this )  However, I really do appreciate all the work that goes into our meals - no refrigeration, no electric stove or oven... it would be hard to cook for a big group in Africa.  We are invited out to a staff's house for dinner tomorrow and they are preparing "game meat" - I think gazelle or antelope is on the menu.

Then back to whatever work I am doing until the end of the day around 5 - then washing up again, a light supper with the group and then usually we have a bit of conversation, or computer time or reading until the satellite modem is shut off.  Some days there are power outages, but so far we have had power most of the time.  Each day so far has had a bit of rain - but the temperature doesn't drop below 70 at night - and gets up to 80 or 85 in the day.  Kitgum has beautiful, vast skies that somehow seem different than home.  Maybe it is the flat landscape or the lack of pollution (although there is plenty of dust).  You'll just have to see it someday - yes, and open invitation to come back with me.

Off to bed - under mosquito netting.  (don't worry Steve - I am also taking my malaria pill)

The journey and the destination

Hello readers! You will have to wait a bit for an explanation of the picture attached...

I know that some of you will be disappointed to hear that my travel to Kitgum, Uganda was not nearly as eventful as the last time. No bus fires, hitch hiking, or traveling with stealthy chickens.

I caught a ride north to Kitgum with a staff member from IGF (Irene Gleeson Foundation), who was transporting a refrigerator and a radio transmitter from Kampala in a truck. (No, I got to ride in the cab, not in the back). One funny sign in a village on the way advertised an office for SLAP - Support Least Advantaged People. I almost asked to stop to take a picture of it, but didn't think quick enough. Is that the worst possible acronym you have ever heard of? I cannot imagine anyone even wanting to go into the office to ask for help :)

The ride was more green and lush than the last visit because of the rains - which also meant some washout areas. However it was only a 7 hour drive - with the last segment from Gulu to Kitgum being similar to riding on the inside of a washing machine for 2 hours. Taking the larger bus may have a distinct advantage on this last section. It seemed surreal to see little children walking along the road with large jerry cans of water on their heads, or women with a child tied to their backs and carrying jerry cans in both hands and on their heads. There is pretty much nothing to complain about when you see that.

At the end of the long day's travel there was a beautiful rainbow that seemed to end at Kitgum - a sign for me. Irene was there to greet me, and I finally met Dr. Andrew - an Australian family doc who has been here several times and is encouraging me to partner with him in the medical work here. He is a very warm, compassionate doctor and I am going to be very lucky to work with him - I have much to learn. There is another Australian couple here visiting as well (I am outnumbered by the Australians - I am the only white person without an accent :) He is a mechanical engineer and she is a retired pharmacist - so we are all gainfully put to work here.

After being awoken by roosters at 5 am (earplugs tonight for sure) - I sat down with Andrew to hear about what he has been doing here for the last couple of days. Then he showed me around the clinic area - which is very simple but impressive. Would you believe he even has an electronic medical record system for the clinic? There is still much to do as far as standards of practice/lab testing/ approaches to common problems like fever/cough etc. We have a lot to learn about a whole array of new diseases in the differential diagnosis of a symptom - in other words typhoid and malaria are not usually in my differential at home!

I then was asked to see an "old" man in the hospice ward. Sure - something I might actually have some experience in... When I got there and heard his story - it turns out he is only 55 but looked 80 - very thin and obviously dying. He had AIDS and TB and the question for me was whether the TB meds were the possible cause of his lack of appetite and obvious decline. I spoke with the wife and son, as well as the medical officer (a young man who is the equivalent of a doctor here - but probably more like a good Physicians Assistant in the US) and we talked about the various options. I thought we should give him some IV fluids in case dehydration was the cause of his decline over the last few days. (He was basically unresponsive at this point). He did not seem to have any physical discomfort - which is good because there is not any morphine or other opioids in stock (Note to self - fix this issue before I leave). I'll check on him tomorrow, but I dont think anything can stop his decline at this point... he is in the right place.

I was pulled away again to examine a little orphan boy (whose name is DAVID! ) who had only weighed 2 pounds when he was born prematurely about 5 months ago - now he is about 8.5 pounds. He was doing well except for an inguinal hernia (note picture above). Some of his intestine had gone through a weakness in his abdominal wall into his little scrotum. So I felt like a monster as he screamed and I tried to gently maneuver (or "reduce) his hernia back into his abdomen. No luck. So I packed him up with his "grandma" caregiver from here and we went to the Catholic hospital. We got prompt help and within 30 minutes we were waiting for the anesthetist. The young African medical officer welcomed me into the operating room where I helped a little bit (if holding a retractor is helping) while he did the operation. Good news was that the bowel was not ischemic and pinked right up when he got it out of the hernia opening. He should make a full recovery. It was a great privilege to be part of helping him avoid an early death - especially since they had worked so hard to save him from his low birth weight and prematurity.

It was a busy first day - I have a lot to learn, and a lot of listening to do so I can hope to be sensitive to the needs here, and not just tell them how we do things in the US. Thanks for reading!

Getting ready to leave...

Many of you received my intermittent, wandering emails during my last Africa trip and so I wanted to improve on the process with my return trip. Welcome to my blog!

I sincerely hope that my bus ride/travels will not provoke as much laughter as the last time - really I do. However, "best laid plans" never work out in Africa, so check in occasionally to read how I have stumbled or had to switch to "Plan B".

Plan A at this point is to get there (27 hours on planes), then connect with a great taxi driver we met last time. He and I will be trying to find a rental 4WD vehicle to bring up a refrigerator for the clinic medicines and a new radio transmitter for the radio station in Kitgum. The two of us will then try to navigate ourselves up to Kitgum (I'm sure I'll be a big help navigating through the bush- but Steve has his doubts). The next 2 weeks will be spent in working on teaching the nurses/doctors, building relationships with the local hospital and government offices, procuring medications and lab equipment.

I am also taking girls hygiene supplies - and doing some health education teaching with high school girls. See the great website for daysforgirls.org for more information on this simple but important project. (This itself may provide some humor... At immigration into Uganda - "What do you have in this suitcase?" "I have 50 pounds of feminine hygiene products sir" "What?" (as he looks me up and down). "How long will you be staying in Uganda?" Enough said - you will have to stay tuned for that one.

There is another blogsite yotkumuganda.blogspot.com which is written by the Australian doctor I am working with in Kitgum Uganda as well. He will be writing about the progress on the clinic we are developing on site at the school in northern Uganda. You might be interested in his blog as well. I am sure you will get more accurate information from his blog. :)

Thanks for your good wishes and prayers...

Laurel