Heart Aches

May 20, 2009

Oh what a day! I don’t think we did much more than we do in a normal day around Mulago Hospital and Kampala, but some things seem to have made a bigger impact on us all.

We started the morning with a walk down to the main hospital. A patient that we saw yesterday had a perforated bowel, which means that the contents of his stomach and intestines were filling up his abdomen, causing his stomach to be very enlarged and painful. He was at risk for dying from an infection or some other complication due to the perforation. The doctors in the ward didn’t seem to catch it on the x-ray, but Ross and Troy did. I’m sure somebody might have caught it on the x-ray at some point, but probably not until much later (days) at the rate things go here. The doctor in charge arranged for a transfer to surgery almost immediately. It’s the first time I’ve seen a patient’s orders being carried out within the same hour as it was prescribed. When we arrived in the surgical ward, I was not expecting much. Troy had checked on the boy’s status yesterday afternoon and the surgeons told him that he wouldn’t get surgery because they were too busy! Apparently there is no priority for emergency situations, so I guess it’s just a first come first served type of thing. The waiting area was full of people waiting on mats for their surgeries. A guard has to stand at the door to control who goes in and out. Luckily for us, when you are doctors from another country, nobody really checks when you walk in. We found our patient after looking in two wards packed with people that are pre or post surgery. We was wrapped in a blanket and hooked up to oxygen and an NG tube that removes “stuff” from his stomach. His mom let us look at his chart. Surprisingly, he had gotten the surgery! The notes said that they repaired the tear and they hadn’t closed his abdomen yet. We uncovered him to find tape over his belly. He was still working really hard to breath and didn’t keep his eyes open very much, but at least he was alive. Even though he got the surgery, he still might die from infections, but he was given a better chance because of the surgery. We don’t know if he will be there tomorrow, but hopefully we’ll be able to try and check again soon.

We went back to the children’s ward to meet up with a doctor named Justice who is the neurosurgeon that would look at the boy who has become paralyzed and developed scoliosis from something that has not been diagnosed. Justice was supposed to meet us at 8:30. By 11:00 after rounding with some of the other doctors and following up with some patients from earlier in the week, we decided he wasn’t coming. Troy called and Justice told him he wasn’t even at Mulago today. We weren’t shocked when later in the day another Ugandan doctor told us she had eaten with him at a canteen at Mulago. I don’t know why he found it necessary to lie and to not actually come to see his patient, but he’s done it before. Last year we went to find him shortly after we arrived and were told he was out of the country. We sat outside his office for about an hour and eventually he emerged and then looked surprised to see us! He had been sitting in that office and told his assistant to lie about his whereabouts! He’s not the only one who does these sorts of things and that’s what’s so frustrating about trying to get things done at Mulago. I watched Ross and Troy conduct a physical exam on the partially paralyzed boy to determine what might be causing his ailments. It was so amazing to see what they could discover based on reflexes and responses to pain that he had. I don’t know how they did it, but they could determine that he has a tumor and that it is located in a particular region of his spine. However, in order to treat it, the boy will need a CT scan. It will cost 150,000 shillings, which is more than the mother has. If Justice would right an order for it, the cost could be cut in half. That’s not happening anytime soon and we couldn’t communicate with the family because they don’t speak English, so he and his mom will sit there and wait for a long time.

Priscilla is actually doing a little worse today. She is walking with a little less steadiness and she is no longer could control her urination, so she wet her bed while the doctors were watching her. It probably means that the fluid is building up and putting pressure on her brain again. She needs to have the tumor excised. By the time we were ready to leave for the morning, we were told she was being discharged and her mother was going to take her to the hospital that could remove the tumor. We went over to say goodbye and her mother said that “poverty” is a problem and she wasn’t sure she would be able to find a way to pay. We told Priscilla that we would pray and ask Jesus for her and she smiled and nodded. Ross told her she had to ask him too and her mother was thankful to us for spending time with them. I will be praying that Priscilla will get her surgery and get better. She is too sweet to be sick!

There is another baby in the ward that is a sad story. We saw her throughout the day and thought she was the cutest little girl. She is severely malnourished and she was wearing a knitted white hat with purple trim that was almost as big as her body. She was eating a big bun piece by piece. She giggled a little at us the first time we walked by her. Later I brought her a little stuffed elephant and she didn’t know what to do with it. I saw a nurse bathe and change her a while later and thought that was strange because I’ve never seen a nurse do the jobs that mothers usually do. We found out later that the girl had been abandoned at just about two years old and the nurses have been taking care of her on the ward. Tomorrow I hope to bring up some of the very small clothes that we brought that I didn’t know what to do with and maybe just hold her for a bit. I know that the nurses don’t have a lot of time to just sit with her, so she basically just sits in the bed all day, eating and occasionally having a nurse stop by to check on her.

This afternoon was the most heart-wrenching thing I have seen ever in Uganda. We had talked with Susan, the director of international medical students coming to Mulago about finding a small orphanage without a lot of funding. She told us she heard of an old lady who took kids in somewhere in the slums. She decided to take us to try and find her. So many times we have walked by the outskirts of the slums or down a street or two, but never actually gone in. We drove to a spot and got out to walk the rest of the way. Susan asked a woman who was crawling around on the ground (we don’t know why, but she doesn’t get off of her knees) where to find this woman. She directed a boy on a bike to take us there. We wound through streets full of garbage. As you walk by the doors of people’s homes you could smell the rot and mold inside. I could see near the trenches that the streets are piled with garbage underneath all the dirt. I think that’s all that the slums are just garbage used to make other things. We finally arrived at “the place” there was a putrid smell coming from it. Outside, there was one pot cooking on some coals and right inside the door there was another. I have never walked into a place that brought me to tears simply by seeing it. In the dark room there were six beds all lined up with about 8 inches to walk around them. Dirty boxes lined the walls. Soon, all of the children (18 of them) came inside and were sitting or standing in that little room. Every time somebody moved, more dust and dirt entered the air. You could see bugs crawling on the blankets. The old woman doesn’t speak any English, so Susan explained to her what we wanted to bring here with the medicine cabinet. She understood and we told her we would be back in the next couple of days with Angella to interpret for us. We were in that room for less than 5 minutes, but I won’t every forget that feeling. I don’t know how people manage to survive in places like this, but somehow they manage. If they don’t, nobody really notices. These are the real “invisible” people of the world. The ones that you hear about or think about but you can never actually understand what it is. The movie Slumdog Millionaire brought us all into that world for a brief moment, but even seeing the movie didn’t make me understand as much as being there and having every sense stimulated by extreme poverty. The little baby on the bed was crying because he was hungry and people are constantly yelling in the streets. The smell is a mixture of rotten garbage and dirty bodies with small hints of potatoes and mtoke cooking in a pot somewhere. People are dark and dirty and sad looking. You can see in their eyes that they are suffering, but holding on and fighting for everything that they need to survive. We left that place with a whole new feeling of this country. We’ve been spoiled by seeing a city with poor people, but now we’re exposed to the poorest of the poor. Even Susan wasn’t expecting it to be that bad. The more shocking thing is this is not an isolated place. When you look from atop any of the 7 hills of Kampala, you see the tin roofs of the slums scattered everywhere. The majority of the people live in this poverty. This old woman they call Jjajaa has taken in 18 abandoned street children and I have no idea how she pays for anything for them. We are hoping that we will be able to make a small difference for this group of people in the next few days. We will go back on Saturday to bring some things and get more information about the children. I really don’t want to ever forget the feeling that I felt upon first walking in there and I’m hoping that we will be able to do something to make it better.