A Drop in the Ocean
I have just returned again from my second home and whilst I am familiar with all the adjusting that has to happen when crossing cultures and privileges it doesn't get any easier. I travelled by myself for this trip as I needed to concentrate on 'admin' type work (more later) but that didn't mean that the 'real work' was prepared to stop and let us get on with it! Also, we were handed some money just before I travelled out and told to 'feed the children' and help people. This meant that we were able to support with gifts of food (a real humbling honour) some of the most vulnerable there with donations of posho, eggs and beans, and also able to remind people of how to maximise the nutritional value of these foods. As ever, Yakub or the VHT (Village Health Worker) gives this advice because it is more 'accessible' to act on if given by a local person. We also used some of the donated money to buy standing frames and wheelchairs for those children who are regular attenders for physio and whom the therapist feels would benefit the most.
It was during a delivery of foods that we got a call from Jina Main Referral Hospital. They had two very sick young men (one had been involved in a traffic accident and another had been beaten up and robbed) and their only chance of survival was to be taken to Mulago Hospital in Kampala. They were so sick that we were anxious that they might not survive and suggested that we fuel the hospital ambulance - but apparently not only did it not have any fuel but it was also broken. Without any other option we requested an accompanying nurse and loaded a large oxygen cylinder into the middle of our vehicle (aka Nellie). Sadly the connector was faulty and it leaked despite our attempts to secure it (using latex gloves and tape!) and it ran out about 25 minutes before we reached the hospital (Yakub drove brilliantly but the roads are dreadful in traffic and condition) and we could see the poor man's struggle increase. We were relieved to reach Mulago with both men alive but we did hear that one man passed away early the next morning. It is heartbreaking that such a sick man had to undergo a dreadful journey that did nothing to benefit him - but we had to try.
Two days later the story was repeated, with another call about two children, one who was in respiratory distress after 'swallowing something' a few days earlier, and a beautiful young boy with an emergency referral to the Cancer Institute at Mulago and who was bleeding from every orifice. This time they sent a student nurse who was not confident with managing his blood transfusion and I had to call on my very rusty skills of keeping IV's running. We also had a nasty incident with the traffic police who objected when Yakub (quite safely) moved to the head of their road block; because we didn't have the word 'ambulance' written on our vehicle we should not have moved ahead apparently! Sadly we haven't heard the outcome for these boys but the business of Tusc is definitely one of unfinished stories. It was of great concern a couple of days later when we had another call from Jinja Main for emergency help but we were far away with a vehicle full of our 'Friday Friends' (the children that we take for physio every week), and we can only hope that this prompted the Admin' of Jinja Main to organise the repair and fuelling of their vehicle.
Another 'dash' we had to make was for a young Mum who had delivered her baby with the help of a 'TBA' (Traditional Birth Attendant) deep in the village ten days earlier but who was now collapsed with a secondary post-partum haemorrhage. We were called by Mpumudde Clinic midwives to rush this lady to Jinja Main Hospital and we are glad to say that despite her very serious and collapsed condition she was reported to have been 'slowly improving' when we enquired the next day; as an ex midwife I fully understand the great risk that she was at (and had she died, which she wasn't far from, then the chance of her baby surviving would have been small), and was very glad that we had been able to get her to the Main Hospital in time.
Outreach work continues to be supported. The wonderful Salama follows up people who default for their medication or those who are very sick and her and Yakub make a wonderful team, with kindness, respect and intelligent and gentle advice being given. Because we are able to transport Salama and other staff (to undertake immunisation programmes, screening for HIV and other health promotion work) then more people can be cared for. There are no clinic vehicles or facilities provided by the 'authorities' for staff to go further than they could walk, so it's thanks to our amazing supporters that we can help the staff to have a greater impact for people. During a HIV testing session - just on the side of the road by a little village shop (!) I asked why the staff weren't encouraging people to take the condoms that were there - but I soon learnt that people are concerned about what questions using these might raise in a relationship. Women were anxious that their men might feel they were 'questioning' them if they asked them to use them and it was apparent that greater language skills than I had to counsel people on negotiating within relationships and more time than Salama and Yakub had, was needed.
I always leave Uganda worrying and sad about somebody - not sure if it's my default position but just before I left a lady that we often transport for medication (she is very sick and weak) asked us to see a baby that lived in the neighbourhood, and that is how we came to meet baby Enoch. This little 6 month old baby boy had been born with a large but intact spina bifida (and he was showing signs of cerebral palsy too) but he has a heart condition that means that even if the family had the money to pay for the surgery, the hospital won't touch him until he is cardiacally stable. We took him for ECG and Yakub has liaised with the cardiologist about the results; so far it isn't looking too good but they have agreed to review him and from the donations I was able to take out, if they can stabilise him we can pay for his surgery to reduce the pressure on his brain. Let us hope for the very best for this lovely little one and his family.
In between all this the 'admin' stuff was still demanding - but it was for a great reason! We have been gifted the wage of a nurse by the Anam Cara Trust and we needed to advertise, short-list and interview, and also learn how to pay their taxes and secure indemnity insurance. It doesn't sound too onerous but as its in a country very differently organised than our own I found it quite challenging. And because we want to second our nurse into Whisper Children's Hospital and St Francis Health Centre one day a week, we also needed to co-ordinate their availability for interviews. Happily we now have a Diploma Registered Nurse who is just undergoing induction but who will support Yakub and Salama in their everyday work and enhance the care that we can give to people - to say that we are humbled and grateful for this opportunity is an understatement!
Uganda continues to hold my heart and raise my blood pressure with fury..... we see amazing people working incredibly hard to help, and we see people who could do more and don't. Our service is so minutely tiny compared to the need and we really are just providing a drop in the ocean ..... but then again, the ocean is made up of drops so on we go!