November 16, 2011

I haven't blogged about my trip in a while and to be honest, its because this day is hard.  Hard to remember, collect thoughts, hard to process.  I guess I've been avoiding it because I wish that I could make it go away, but the images from this day will never leave my memory, maybe through this post you can come with me on my journey to make a difference so days like Nov. 16, 2011 never have to happen again.

Journal Entry:
   "Today hurts.  I am not God and I don't claim to be wise, but quite honestly I'm angry at the way he chose to let things go today.  Sometimes asking for a miracle doesn't mean you'll get one.  Sometimes the right way doesn't work and you feel stuck. Stuck between knowing what to do and not being able to...... Today started off crazy.  On the way to the hospital we ended up stopping to help a huge van attempt to clutch start.  This was the first of many failed attempts to do good today.  We arrived at the hospital and like usual I started to round on the patients in the maternity ward.  This morning no one really wanted to help.  It's so frustrating not knowing a language and not being able to say what needs to be said.  Today in particularly I felt overwhelmed by my lack of maternity nurse skills.  I hate being ignorant not only in this particular type of nursing, but how to do this in Uganda without the normal tools and equipment.  I felt broken, I really needed God carry me today.  I needed him to be big because I am and felt so small.  So in the midst of this chaos and confusion during rounds the midwife student runs in to tell us a baby that was just born was not breathing.  I go running to the back to find a blue baby,  she wasn't breathing on her own.  They claimed she had a heart beat, she didn't.  I looked up to the doctor that is normally in charge of the maternity and pediatric departments and he asks "Do you know how to resuscitate a baby?"  I respond with yes, and immediate take control of the situation.  I was the only one who knew what to do.  I initiated compressions and started bagging her. (merely pushing room air into her lungs, because we had no oxygen.)  We got a heartbeat back  and I took her to the OR where we could intubate her and have some suction.  We got her intubated and gave iv steriods but we didn't have anything else.  She had her own heartbeat but we were making her lungs breathe.  Here they normally quit when they aren't breathing, they don't go beyond that at all.  It was so hard knowing all the next steps that I would be taking if I were in America, but that is impossible here.  I kept giving her breaths for over an hour while the anesthesiologist convince me it was time to stop.  My sweet friend Rachel (with no medical experience) continued to pump air into her lungs while I cleaned the baby up.  I took out her IV (which was just a hallow needle which I used 3 times to stick). I swaddled her up and we took out her breathing tube.   My stomach sank as this baby had no breath, just a heartbeat and there was nothing I could do.  I took her back to her mother and let her feel her baby's heartbeat.  I had to tell her that it probably wouldn't beat much longer, because she's not breathing on her own.  I prayed with the mom and for the baby and we waited.  Her heartbeat slowly faded from being able to feel it to only being able to listen with my stethoscope.  And at around 1:30 pm it faded away completely.  It was so hard to watch this precious baby girl's life fade away.  Then I had to get a translator to tell her mom that her baby girl was gone now.  It seemed as if the mom and our team we really the only ones phased by this.  This is a norm there.  Babies shouldn't die.  I went for a walk for a little bit and prayed.  I prayed for the mom who just lost her baby and I asked God to be glorified through this and that his power would be made perfect.  I wish I could have a conversation with this woman and promise her that God is still good and that he has a plan for her, but our languages wont let me, so I asked God to tell her himself.  There is still so much left to do and I can't do it all so I choose and remember to leave it in the Lord's hands, knowing that his foolishness is wiser than my wisdom and even though I wanted a different outcome, that doesn't mean that was best.

I go back to the maternity ward to finish rounds.  No one was there to translate and after 30 minutes we finally got someone to help, but not someone that could do the orders I was writing. Finally one of the nurses got here to do the things we needed and after much frustration and firm talking patients started getting treatment.

Then I got to the point where I could assess the sweet baby from yesterday.  He was cold, barely breathing... the whole event from this morning was basically replaying itself in this sweet boy, Andrew.  I ran to the OR to get the one infant ambu bag we had and gave him a few extra breaths to help jump start his own.  We quickly decided that if this baby was going to live he had to be rushed to the Mbale hospital (an hour an 15 minutes away)  So Katie and I jump in an SUV with an African Driver that served as our ambulance.  During to trip we had to initiate CPR on the baby while on these bumpy roads, trying not to crush his little head while attempting to pump air in his lungs.  We finally made it to Mbale and were surprised to see the only real difference was that they had oxygen and they had a store up the street that they could buy an NG tube from.  While these were very necessary and helpful they didn't have bililights, warmers, or vents there to help this baby.  Tonight I left this baby's life in the hand of the Lord once a again as he struggled for breath in Mbale.  Man I wish we could do more for these kids.  It doesn't seem right.

Katie and I were at Mbale hospital (Which by the way it only took 35 minutes to get there... umm can you say flying?)  Then we had to get to the hotel that the rest of the team was eating dinner.  There was no other way to get there besides a boata boata (a dirt bike type of taxi)  I think our trip leader gave us one rule for the entire trip: Do NOT under any circumstance, get on a boata boata.  African roads+ No helmets+ crazy drivers often = death.  But we didn't really have other options so after much warning from our native friend Sam the boata boata driver agreed to get us both to our destination safely.  Picture this: a Ugandan driving in front, katie sandwiched in the middle and me gripping on for life on behind her with both of our back packs piled on my back.   We arrived safely after another scary ride during which I was wishing I had peed before hand.  We made it without peeing our pants or any scrapes or bruises.  We had a relaxing dinner, during which I was pretty quiet, so much so I was making myself nervous.  I really don't know how to process today.  Katie, Sarah and I had a worship session that really helped me to connect with the Lord and really see his face through this hard time.  Hoping to get to bed early tonight and to get some good rest for tomorrow."
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Nov. 15, 2011

My heart breaks today.  Apparently delivering healthy babies in a 3rd world country isn't as easy as yesterday made it seem.  I'm still working in the maternity unit and rounds this morning were very frustrating.  Since I had already done this once I knew a little bit more how to jump in today.  Unfortunately, the nursing staff seemed like they weren't as willing to help me.  They didn't really want to translate for me, instead they just kind of spoke for the patient.  When I asked her to ask the patient if they were in pain, she would tell me they weren't with out even asking.  This made rounds very difficult.  I was actually able to write for some labs and discharge a couple patients.  Then we rounded on one patient that looked very sick, seemed to have a fever (we don't have thermometers here) and I was concerned she might be getting septic.  We started some antibiotics and gave her a fluid bolus, and I really hope she perks up more by tomorrow.  I've told the nurses to keep a close eye on her blood pressure, but it seems they don't really take vital signs that often. 
After I got this woman settled I continued rounding and 2 patients later I came across a mom that was readmitted because of possible sepsis, for IV antibiotics.  She told me that she had fed the baby and that he was eating well.  So I uncovered the baby to access him and words can not explain the gut wrenching shock that overcame me when I saw this malnourished 32 week twin that was 7 days old.  I could see his heart beating behind fragile ribs that were so well defined with sunken skin between each one.  He was nasal flaring and retracting, working so hard to breathe, most likely because of being malnourished.  His skin was yellow and his eyes glowed from jaundice.  At home this baby would have been intubated on a ventilator, with nutrition going in through an IV,  under bili lights and a warmer at least.   He wasn't even a patient here.  The mom was the one admitted.  Needless to say, with my flip flops kicked on the floor and knees folded indian style on an African bed I nervously stuck this kids rolling dehydrated veins with hope of the ability to infuse mere drops of fluid, something his 7 day old body, had never tasted.  After all the commotion, it came out that this 16 year old mom had actually never tried to feed this baby yet.  It turns out that mom believed in a superstition that meant that she wasn't allowed to feed the baby until a certain ritual had been performed.  If she did feed the baby, she thought the baby would be cursed.  We got a translator to help us speak to this woman and we were able to tell her about Jesus and that he could remove that curse so that the baby could eat.  We prayed with this woman and she was willing to attempt feeding the baby.  We put the baby at her breast and his weak frail body was able to latch only slightly.  After a fluid bolus and some maintaince fluids he arroused a little more.  I've never been so excited to see a baby swallow in my entire life.  Pure joy.  We were able to expell milk from mom and feed it to him through a syringe.  Just to see him take 5cc made my day.  I left him with IV fluids running and I'm terrified that when I go back the entire bottle will be infused.  I made sure all the nurses know that he only need to get 3 drops a minute and absloutely no more.  My stomach churns wondering what to expect when I find him tomorrow.   I have to leave his life in the hands of Jesus, just like it's been for the past 7 days.  I pray for this sweet baby to live and be able to come to know the Lord and serve him with his miracle of life.   Sleep will be hard.  Praying that new life sustains.

November 14, 2011

Wow!  What a day! I guess this is what I would call our first real day at the hospital.  I got assigned to the Maternity Ward.  Everything I know about maternity nursing I learned in a classroom over 4 years ago.   Things weren't really organized at all so we just kinda jumped in to help when and where we could.  It turned out that I was the only one that rounded on the patients in the maternity ward and I was the one writing orders to be done...umm yeah I was more than a little out of my scope of practice.  One of the hardest things today was getting used to their different medications, equipment and ways of practice.  For example, they didn't have ultrasound machines so we listened to fetal heart rates through this aluminum funnel thing.  We wanted to induce labor on another woman but didn't have any IV pumps to drip medications.  Also, they call all the drugs different names.  I really felt out of my element and had to rely on the medical staff there to not only help me to figure out how to treat these women but for translation to even be able to talk to them.  Most of the staff at the hospital were actually students or government paid employees.  The government didn't really check in on them or have any kinda of accountability for them so sometimes they would show up but other times not. 

We made it through rounds and I effectively treated 14 maternity patients.  Just when I thought I could breathe a sigh of relief I hear screaming from down the hall and in the delivery room.   I run into the room to see a woman in labor on the ground with the baby's head half way out.  Looking around I quickly realize that I'm probably the one most qualified to help besides the Ugandan Midwife student.  So I gloved up and we helped get the baby out the rest of the way.  We cut the cord and cleaned him off and assessed him.  He was a healthy 2.2kg beautiful baby boy. Wow, I helped deliver a baby. My first successful delivery in a third world hospital with no electricity, water, epidurals, nothing.  Once the baby was cleaned up, I got to hand him to one proud mother. I have to admit I was pretty proud at that moment, too! To help bring new life in the world was so amazing.  Words can not describe the emotions and excitement felt from this experience.
 This afternoon I helped in the children's ward a little.  I was helping to hold for an IV and they used the same needle multiple times on the child to stick for an IV.  They didn't use gloves.  Their standards are no where near what ours are at home.  I am excited to help with this hospital and see the changes that are to come.  Can't wait for to tomorrow.  I'm ready to jump in again!

November 13, 2011

This morning I woke up to French toast wonderfully prepared by our host Pam Porter.  I was shocked to see such a wonderful breakfast.  The food here really isn't bad at all.  I don't think there has been anything that I've really not been able to eat.  Lots of beans and rice, fruit, avocados, and peas, nothing to crazy so far.  In fact, it's all been really good.  Today was a down day because the hospital was closed.  And by closed, I mean the sick people were still there but no medical workers, the patients just kind of take care of themselves on Sunday.

This did give us a great opportunity to tour eastern Uganda a little.  I didn't know but Uganda has beautiful mountains, gorgeous water falls, huge lakes, and it's actually where the Nile river starts.  So today we went hiking up Sipi falls in a mountain range close to the border of Kenya. We rode the van up muddy streets on the side of mountain and I prayed more on that ride than I think I have ever prayed in car.  Actually, I'm quite terrified every time I get in a car in Uganda.  Eventually, we made it to the falls and it was worth it.  This place was amazing!  Looking out into the vastness, one could only assume a Great Creator.  We hiked for 2 hours through the mud and under and on top of the falls and it was awesome to say the  least. 

In the beginning of our hike a local boy named Peter started talking with me.  He was 13 and spoke really great English.  He immediately became my best friend that day and helped me up rock stairs and held my hand while we slipped through muddy paths.  I did find out later that he really just wanted money from me, but it was great talking to him about his culture.   He told me about the falls and the people who lived on the mountains, he taught me different types of plants and showed me coffee beans.  He said that where he lives they all go to church and he has always been a Christian.  I got to tell him about my wonderful church in America and what Jesus' life and death and new life, means to me.  Peter is still processing a lot through his faith, but it was a blessing to be able to chat with him.  I'm hoping to be able to get more opportunities to share my faith in Jesus and what He means to me with the people of Uganda.  I'm excited for whats to come. 
Tonight we've pretty much just been able to relax and hangout as a team.  We played some games (I won, lol).  It's so fun getting to know our team.  They are all so hilarious, I've laugh until I've cried or stopped breathing so many times already!  I am excited to see what the rest of this week has in store!

November 12, 2011

Well 7 am came early, but 12:30 and 2:30 am came earlier as my eyes stared at mosquito nets trying to conjure up sleep.  Unfortunately jet-lag got the best of me last night and I was up from 2:30-4:30, reading and trying to make myself tired.  So as you can imagine I wasn't my fully energized self when the rooster started crowing this morning at 6:30.  A luke warm shower and a quick breakfast gave me a burst of energy and we were off to Bugobero hospital.  About 2 rough and I mean rough hours later our now sore bodies unloaded from the back seat of the death trap, um I mean van.

 We were finally there, the hospital, I'd been waiting to see.  Things were very different but seemed to work reasonably well.  IV bags were hung from window seals, using gloves was more of an overlooked suggestion than a routine, but over all I was pretty impressed with the staff's ability to make the hospital run without what I would view as necessary resources such as water or electricity.  Today we didn't really get to pitch in and help much, because it's a Saturday which means they really don't do as much.  We toured the hospital and of course we played with children.  (I taught them many games like racing games, follow the leader, the knot game(not so much a hit), and duck duck goose.)  They laughed and laughed and laughed.  I am completely convinced they were laughing at us more than with us, but hey they smiled.

During our tour we quickly became aware of the harsh reality of health care in Uganda.  One woman we met got to celebrate the birth of healthy twins, but this wasn't so much the norm.   I also met one poor woman who seemed to be in a lot of pain.  They said that her 32 week old baby had already died inside her because of malaria.  She'd still have to deliver him soon.

Malaria is the number one killer of unborn babies in Uganda.  Mom's get the disease which can be treated but after being treated the virus still lives in the placenta which is where the baby get's it's nutrients.  Also the drug used to treat malaria, Quinine, is toxic to the baby.  So here are the options they have, 1. both mom and baby die from malaria, 2. Treat mom with Quinine and make sure to get the baby out with in 2 days of treatment.  (which if the baby was less than 32 weeks of gestation this was incompatible with life as well.)  So something totally not of issue in America, something completely preventable, is claiming the lives of thousands here daily.  That's why were here.  My prayer is that change can result. I think that, first of all, people need to know that this is happening to be willing be a part of seeing it changed. I watched this short video about the malaria epidemic vs the swine flu out break and realized that these numbers can not be ignored!  If you would like to be part of helping to prevent malaria, you can help save a life today by donating a pretreated mosquito net to someone in Uganda.  Just go to this website, though the same organization I traveled with, choose Net:worth and for every $10 you give, a net will be distributed to someone in Uganda who needs it.  Also, once the net is distributed, you will get GPS coordinates of where your net is located and a info about the people it's protecting.  Baby steps,  I'm learning that God uses the willing heart of believers to make changes that impact eternity.  Will you join me in this baby step?

Back Blogging Uganda Trip: Nov. 11, 2011

Do you remember your first roller coaster ride?  I'm not talking about the pirate ship that goes back and forth or the baby roller skate shoes that you ride in, I'm talking about the one your mom or your older cousin or who ever had to pretty much bribe you to get on.  Remember that moment when your life wasn't yours any more?  Your life rested in the 2 inch wide strap across your lap and a piece of metal that clicked tightly over your shoulders.  The next thing you know you are flying through the air going back and forth not really knowing where your headed next or what way was up.  Then suddenly it ends and you've just experienced something all people under 48 inches will never understand.  I feel like I've relived this experience the last few weeks as I adventured this short term medical mission trip to Uganda.  In this, and the next few, posts I hope process with you my experience in a way that you "less than 48 inches" people can understand, relate to and ultimately desire to be a part of in some way.  

November 11, 2011

The last couple of days have been a whirlwind as 10 of us strangers, though siblings in Christ, set out on our adventure to Uganda with the one goal in mind; serving the people of Uganda with the skills and resources God has blessed us with.

MEET OUR TEAM, WELL MOST OF US:

  We met in D.C. and on the plane I was informed that the next 12.5 hours would be spent snuggled up next to some of these strangers.  They weren't strangers long.  We watched movies together shared life stories, played cards and anything else that could entertain us for this long trip to Ethiopia.  I was so excited to be flying over the Atlantic again.  Excited to see how God would once again prove himself God of the nations and break down the boxes that I try to put him in.  Excited to see how he would use me to bless others and how he would use others to bless me.  Excitement, that was pretty much the only emotion I could experience these last few days.  We had a lay over in Ethiopia and then finally set out on the final leg of  our journey to Uganda. 

We spent the next 9 hours trying not to sleep, and wondering around the city of Kempala.  I noticed that this city is relatively a nice city, one that has luxurious hotels and golf courses, malls, and buildings with revolving restaurant on top, not exactly what I expected of Africa.   We haven't had too much interaction with the Ugandan people yet but from what I can tell they are so welcoming, they are excited we are here and have such a gracious and giving spirit.  Though it was nice to spend a night in African luxury the next day we headed out to Mbale and small town in east Uganda where we'd be staying.

On the way we stopped to meet Bob Goff.  Bob is a Lawyer from L.A. who, through researching Ugandan law found out he could be on Uganda's supreme court and so he did just that.  Bob Goff is trusting God to use him to help be an agent of change towards justice in the corrupt country of Uganda.  He's been able to help give trials to innocent people living in Uganda's prisons and he's help to pass a law that makes child mutilation illegal, as it is still practiced by many of the witch doctors there.  We actually met up with him at a hotel where he was having a conference with a room full of witch doctors.  He cordially invited them to a lunch there to share his story of how he has successfully prosecuted the first witch doctor that was caught mutilating a child.  He also informed them how this man is now in a probably one of the scariest prison on earth for the rest of his life, and that this law is easy to prosecute and has been and will be enforced.  We got to see this child that was the victim of this witch doctor that had been prosecuted.  He was a real kid, not just one read about in horror stories.  I looked into this kid's eyes in 2011 and saw a soul that was a victim of terrorism that shouldn't exist in this day and age.  This doesn't have to happen anymore and Bob Goff is one that is making sure that it never does again.  Bob's belief in God's redemptive and restorative plan also led him to share the gospel with the witch doctor in prison and help this little kid get connected with plastic surgeons in the states to help make him "normal" again.  I am amazed to watch God work through just one person willing to take a stance against evil and do what God has called him to do.

After traveling roads that might be better classified as just potholes, we finally made it to Mbale.   Mbale is a small town with running water and electricity and it's about an hour out from the hospital we'd be working at in Begobero.  Our guest house was quite graciously prepare for Americans by our host Pam and Harry Porter, long term missionaries to Uganda.  It had mirrors and toilet seats and mosquito nets! I'm actually quite pleasantly surprised. 

I'm a little nervous about seeing the hospital tomorrow.  Since we are the first Safe World Nexus team to go to this hospital, we are pretty much just an assessment team.  The purpose of our trip is to learn how to help this hospital, what their needs are and what resources and skills we can provide in the future.  We've been advised to learn the culture and the process there and not go in with the mindset to fix it.  I'm sure things are very different and that it will break my heart.  I'm sure I'll breakdown, the only question is when.  I'm already finding myself asking God why and telling him this isn't fair!  Yet I am so thankful that the gospel isn't fair.  That Jesus died so I don't have to and I know that the people in this hospital need him more than they will ever need me.   I write this as the I'm listening to the song God of this City and the lyrics repeat "Greater things are yet to come and greater things are still to be done here."  He knows what he's doing.  I'm learning that God has a way of shaking you out of your familiar and giving you his familiar self, yet so much richer than you've ever known.  I pray for the people we are going meet.  I pray they would be saved, that we would portray our zeal for God, not boasting our knowledge of proper ways to run a hospital, but boasting in the Lord's grace to make a hospital work.  That our own "righteousness"  would utterly fail so that we have nothing to know except for His righteousness. I pray that my heart would break free from it's bondage to the law so that Christ may truly reign and that these people may truly experience him. (Romans 10:1-4)  It's becoming real now.  Not sure I'll be able to to sleep tonight.  So excited!

I am weak, but He is strong

So today I was feeling discouraged, beat down, well I guess you could say I was feeling sorry for myself and loathing in my own bath of self pity, although in my head it didn't seem unjustified or even selfish, but there I was or maybe still am, but thats besides the point.  In that moment of my weakness, I saw the Lord.  Not physically with my own eyes, it was just a whisper but it sounded like a scream.  He was there, with me, by my side speaking truth to the lies in my head, reassuring me that he has the control and power and that He always does and knows whats best.  Jesus likes to show himself in these circumstances, so I've seen.  Where we are weak, he is strong.  I've been reading Acts and one of the most amazing parts of this book that I've read thus far is when Stephen physically sees Jesus standing at the right hand of God.  And Stephen worships God even while he's dying and prays for the forgiveness of others.  God shows up in our weakness.  We can see him in weakness.  He's who we cling to in weakness.  So I've come to 2 questions in my head from this....

Aren't we always weak?  I mean I could probably tough out 30 girlie push ups and have been know to complete 75 burpees (once) but in my heart and my emotions and my control of this thing called life, I am weak... frail if you will.  My good and bad days wean and wade on a factor dependant on an exponential number of outliers that even my number craved brain refuses to attempt on my own.  I have no purpose in and of myself, therefore I am always weak, on my own.

Which begs the question: Why do I think I'm strong? or even: Why do I want to be?   Jesus is my life, in nothing else can I boast because things of this world will fade but he will remain.  I can't make myself breathe, I can make myself not breathe for a couple minutes or possibly, though never trialed, I could make myself not breathe unto the point I pass out and something else causes me to breathe anyway.  Something outside of my control, controls me.  I am not strong, but when I think I'm strong, I  don't see Jesus nearly as much.  He's there, I just don't look at him or when I do it's to tell him I've got it all under control. Which 99.9% of the time is not the case, which he knows but I don't, so he stays around.  He waits for outlier number 4,372 to come jolting out of left field, and perfectly shattering my control into an obliterated mess, He stands there waiting for me to see Him. Some how, seeing him makes it all better.  For some reason, knowing Him as God, the ultimate source of control and yet still Abba Father, daddy, makes it all peace, joy, grace.  So if this is what I get from weakness, why be strong?  Stephen boasted in Christ alone unto his death and in this weakness, he got to see Jesus and his mighty power, perfect plan, standing waiting to call him home.  Paul, who by the way encounters Jesus and his power a couple chapters later causing a radical transformation from dark to light (read it!) could not have said it better in 2 Cor 9.  He is pleading with the Lord about something causing him to be weak and the Lord said to him "My grace is sufficient for you, for my power is made perfect in weakness."  So Paul responds with, "Therefore I will boast all the more gladly of my weaknesses, so that the power of Christ may rest upon me." 

I pray for faith that trusts Jesus at his word that his grace is sufficient and that his power is perfected in weakness.... I am weak, I want to be weak and see Jesus be power.  He does it so much better than I could ever dream of.