Tuesday, February 25, 2014

ROSE

Thanks to everybody who has commented and showed compassion for the children in the prison! It really was a good thing to see and experience but every time I think of it, my heart breaks a little. Since Saturday, I feel like a lot has been done, although it really has been only three days. I have been at the hospital working on the Infectious Disease Ward on Monday and today, but I will write more about that tomorrow or the next day. For now, I think it is important to talk a little about Rose, and think about the world through her eyes for a bit.

Saturday night was seemingly a pretty expected night, given that this was Rose's first time in a bed. She and Zefanya were sharing the bed and unfortunately for him, Rose is very sick. She had diarrhea - foul smelling, large amounts of diarrhea - that filled her diaper, the bed, and trailed her all the way to the bathroom. By the time Renske heard her crying, the mess was all over and Rose was just sitting in a pile of crap.

The first time I saw her for the day, Rose was standing with no clothes on in the hallway outside of the bathroom. She looked and me, then looked away, and proceeded to use the floor as her personal toilet. Renske calmly cleaned up the mess and we both assumed she was done. Just as she finished using soap to disinfect the floor, Rose squatted down for another go. If you ready about diarrhea in a medical textbook they will tell you that it is technically 250 grams or more per day of stool. I don't ever measure amounts nor do I ask patients, but when I saw what was coming out, I knew that this girl was well above the necessary number for diagnosis. She continued to make messes all day and we got to the point where we just sat her on the toilet every hour or two to hopefully prevent more overflowing diapers. Maybe all of you moms out there can relate to having a sick kid, but for me, this is a lot of new messes. In addition to feeling not so good, this girl is malnourished and not accustomed to functioning in a house. If she were back at the prison, she would probably not be wearing any clothes below the waist and if she had an episode of losing stool in an odd place, one of the older kids would likely beat her up for it. At least here, she can be sick and we are trying to lovingly correct her.

When it comes to emotions, Rose shows next to none. When food shows up, she perks up quite a bit and positions herself as close as she can to it. Even though she is not feeling well, she wants to eat. When I got home from my run in the evening, she was making little happy cooing noises, which I quickly learned were because she saw Angella cutting a mango and was trying to ask for some.

On Monday morning, after another long night of diarrhea, crying, and adding to it a bit of vomit, Renske was prepared to take her to the clinic that they usually take kids to. On our drive in to drop Zefanya and for me to get to a good place to walk to the hospital from, we heard noises from the back seat and turned to see Rose regurgitate all the mango and whatever liquids she had gotten last night. Renske later informed me that she threw up for the entire hour long ride to Entebbe and made a huge mess in the car. That night, I was happy to learn that Rose has Malaria and probably some sort of intestinal infection, which is nice to know because they can be treated!! She was started on IV antibiotics (which they allow you to administer at home if you are able) and antimaliarial treatment. We have been giving Oral Rehydration liquid as well, and last night there was no vomiting or diarrhea - just crying because of hunger!

Although physically there is a lot of improvement, I am still quite sad about the way that Rose has developed so far in life. She has probably lived on the street (nobody can tell us because there is nobody that brought her in, she was just collected with a bunch of other kids), she might have been abused in some way, she probably went long periods without eating, and she probably never had anybody to just hold her and show her she is loved. She is like a little rag doll that you can shape any way you want. If you sit her down, she stays sitting until you pick her up. If you stand her up, she won't sit down. The only time she moves is if you tell her to come and show her food or maybe a ball to play with. Today, she looks much better, but she still doesn't smile. She reminds me a little bit of our dog, Rocky, who is inspired by any food we are preparing. I was making juice and she didn't leave my side, but just stared up at me with these beautiful dark eyes. We we sit down for dinner, she gets up to the table and wants to be as close as she can to the food. I am just praying that over time, Rose will grow to experience love in a way that doesn't involve a reward system with food. It is likely that she will go back to the orphanage that takes kids from Kampiringisa later this week not that she is not acutely sick.

With Rose, I feel like I have to realize what happens when I child is really sick and malnourished. Having her at home reminds me of all the hard work there is to rehabilitate a child after so long without living in a home environment. As a physician/medical student, we often just see a very small glimpse of what recovering from illness can be as we examine and tell people how to treat. With Rose being here, I have seen some of the daily struggles of helping a little girl like her. I know there are thousands of other children like her, without a supportive family or feeling loved by anybody. It makes me so grateful to have grown up where I did with the family and friends I have around me. I really can't relate at all to what it would be like to grow up without that support. I am trying to show compassion and love to her and hope that she will slow start to feel something.

One final thought was something that Natalie told me on Saturday that really stuck and maybe will leave you with something to think about. "Kids like her don't feel hopeless. They can't feel hopeless because they have never understood what it means to have hope."

Saturday, February 22, 2014

Prison Party! - Parting Gift = 2 year old

Today was an awesome day……an extremely long and dirty day, but amazing still the same. We left the house at 6:30 am and got home after 7:30 pm. Renske has been working with a group called Foodstep for the past year or so. The organization was founded by a Belgian couple about 6 years ago. They are pretty amazing and the work they do is not easy. They started out on a completely different project in Northern Uganda but when they found out about a "rehabilitation project" sponsored by the government that is essentially a children's prison, they invested all of their efforts to this project.

The prison is called Kampiringisa and is a place where children from the streets end up if they are caught by the police. There are frequently "round-ups" of street children where up to 300 at a time are put into huge trucks and driven an hour and a half (or a 3 day walk) outside of the city to a place where they can't run away back to the city. Although, hundreds escape every year and find their way back to the streets - begging, stealing, or doing whatever they need to survive. The conditions in the prison are not great, and when Nathalie and Werner started out, they were apparently much worse. There is so much I could do to explain the living conditions today, but I am going to stick to the big points and if you want more details you can ask me the specifics. The NGO also has a website http://www.kampiringisa.org

First of all, the only real adults in the prison are the guards, who don't do much except for count to make sure the children are where they are supposed to be and punish them by beating if they are disobeying or if they try to run. There is a social worker employed by Foodsteps that helps with minor things, but not the day to day tasks. This means that the children learn to fend for themselves. They do the cooking, the washing, the cleaning and caring for younger children. There are children as young as 1 year old in Kampiringisa - how a child could end up there is sad. Sometimes a parent simply abandons them to the prison, sometimes they are caught by the police on the streets, and sometimes the parents are in prison so the children are sent to Kampiringisa. The worst is that the government is supposed to be providing the funding to support the rehabilitation of the children, yet little has been done beyond a very minimal amount for food and guards to be paid. NGO's such as Foodsteps have built new buildings, starting a woodworking and leather work shop to make furniture and shoes, built gardens, and provides medical care weekly to the children. They visit every Thursday and every 2nd Saturday have a party with good food including meat and vegetables instead of rice, beans and porridge. The kids trust the Foodsteps volunteers because they are a consistent presence in their lives, which most of these kids have never had.

In addition to the work in the prison, Foodsteps attempts to locate families and permanent homes for children through social workers. If no family can be found, they offer to take the child to the Foodstep home where they have a real bed, clothes to call their own, consistent meals, school support, and basically a loving family environment. The have helped so many children, but the numbers of children never seem to get lower. They have been working so hard and continue to have a positive attitude about their work and their mission. They are truly an inspiration and I hope I get to see more of what they do.

As for our day, we were helping with a group of dentists who came to provide care for all of the children. They yanked quite a few rotten teeth today an did some basic cleaning and preventive care for the kiddos. In the meantime, the rest of us spent time with the kids, helped them eat lunch and dinner, and played games with them. In addition, Renske has been providing basic medical care and supplies to the kids so we help a little with cleaning some wounds and applying some ointments to faces. These are the days that I love in Uganda. I come home and all I want to do is shower because I am full of food, feces, sweat, dirt, and probably lots of other things. Showering is amazing because you wash off a film of red dirt and usually reveal a bit of sunburn and some new scratches and bruises. It's totally worth it to be helping to make an impact in these kids' lives, knowing that the project is very well managed and has been a consistent presence for the kids.

I have a hard time putting into words all the thoughts that were running through my head today. The biggest thing is that I can't imagine these kids are just completely abandoned. They have no family, no community, not even an orphanage that has taken them in. There aren't foster homes waiting for them, there are not other alternatives. It is literally a dumping ground to get them off the streets. If they try to leave, they are tracked down and brought back. Some of the young ones are bullied by the older ones rather than being taken care of by them.

Today Renske was able to get permission to take a 2 year old girl, Rose out of the prison to be eventually placed into Foodsteps. Since they have never had a child as young as 2 and she is basically about as developed as my 8 month old nephew, Renske took her in for at least the weekend to get her cleaned up, checked out by a doctor and hopefully ready to live in a stable, but busy environment. Can you imagine what is going through her head? She doesn't speak any language we understand because she comes from a tribe that doesn't speak Luganda or English. She has only known the streets and Kampiringisa. Now she rode in a private car, had dinner sitting at the table, took a bath (and cried the whole time), and is going to sleep in a bed for the first time ever……ever! That's over 2 years sleeping on the ground or a floor.

I like working on projects like this, and seeing what people really go through in Uganda, but it is so hard to see. Even visiting the country, it is easy to separate yourself from what is really going on if you aren't paying attention to the realities. There are still children abandoned, there are still witchdoctors casting spells, there is female circumcision, there are child sacrifices, and there are kids suffering without anybody in the world to stand up for them. Although I now know many Ugandans who have a pretty good chance in life, with parents, an education, and opportunities, I sometimes forget what happens those that are the worst off. The most promising thing is that Nathalie and Werner along with Renske are showing these kids that people love and believe in them through persistent involvement in their lives and teaching them about Jesus. A favorite part of almost any day trip is the singing. The kids got together with drums, dancing and singing to praise God through music. They get truly excited and are given an opportunity through Foodsteps for a better chance in life.

Okay, that is a long rant, and there is so much more I could say about the day and about the project, but I can only say so much and you probably are having a hard enough time reading through this long length of writing. I didn't take pictures today because it is frowned upon by the guards and I don't like to overstep any boundaries. It's basically a bunch of big buildings without any real private space for anybody. Oh yeah, and there are locks on all of the sleeping rooms so that the kids can't get out in the middle of the night. I think I still need to fully process the entire concept of this place and all of the things that went through my head as I heard stories and saw the children living at Kampiringisa.




Friday, February 21, 2014

Every Day Life

The past few days have been full of a whole lot of random things that I would probably be doing if I were at home, such as cooking dinner, running errands, playing games, knitting, running, and reading books. The only difference is everything takes just a little more effort. I have to keep reminding myself I have only been here a few days because it already feels like I am just doing normal tasks. I hope that once I start in the hospital next week things still feel relatively "normal". I guess I can comment a little on a few of the things I have been doing….

Cooking & Eating
There are three foods that I look forward to more than anything when I get here - Pineapple, mangoes, and avacodos. I have so far eaten two pineapples and 3 mangoes, and am just waiting for my avacados to ripen. I can't wait much longer! Also, I do appreciate passion juice and Angella suggested that I make my own, so last night I cut up a bunch of those little golf ball sized fruits, blended them together and added a little sugar and oranges (which are more like limes) to make my own juice! It was so satisfying to know we made it ourselves and it was delicious! Renske and I also made lasagna from scratch yesterday with a bunch of fresh vegetables from the market. I am not used to having people to cook for and since in the house it is Angella, Renske, and her 6 year old son, Zefanya, we can cook complete meals and eat together each night. It kinda feels like a family and I love it!







Errands:
Running to the store to get a few items is nothing like taking a Target run to University Ave. back home. You have to know what  you are looking for and even then you don't usually know where you can find the things you want. The downtown area of Kampala is the "real Kampala" with hundreds of little shops selling anything and everything you can think of, except for the one thing you are looking for when you need it. We had a list including ink cartridges, pillow cases, and a door bell. Easy at target, right? It is about a 2 hour endeavor in Kampala! The only advantage is that if you go to a store and ask about a doorbell, they might not have it, but usually a guy called a "broker" overhears you asking and tells you they know where to go. You can then weave through the streets and follow them to some obscure shop tucked in a corner. If it's not there, you can usually just take a seat and they will run around looking for what you need. The only downfall is that they usually add to the price as a "finder's fee". Plus, as a mzungu, we know we are already getting a horrible price for the things and we have to haggle hard to get things down. So our doorbell was found after visiting 3 different shops, following a broker, then waiting for 20 minutes for him to run back and forth to find one. In the end we got the price down from 95,000 shillings to 55,000 ($22). We also stopped by the fresh food market, which has just about anything you can grow or catch. From eggs to live chickens, to fresh fruits and herbs, and grilled whole fish (or just a head), it is all there. We settled on a few things for dinner and snacks including my three favorites. One guy wanted 2,500 for one mango but instead we walked 20 feet and got 4 for 5,000. Probably still over what we should pay, but still made me feel like a got a deal!

Running
I have been a lot more diligent lately about running, especially since I got a Nike+ watch with GPS to map where I go and how fast I get there. Uganda is full of hills and dead ends. I started out going at a decent pace and soon realized it wouldn't last with a hill every quarter mile no matter which way you go. I think I passed the same cow 4 times as I tried to find my way home on my first run a couple mornings ago. I was always able to see the apartment building no matter where I was but I could never find a road that actually connected me to it. It was more than a little frustrating. Tonight, I took Zefanya out on his bike as I jogged. (note to anybody that hangs out with six year olds - they will ride in front and not wait for you but as soon as they need to stop or slow down they will yell for you to "STOP, WAIT FOR ME"). Only in Uganda have I used the phrases, "stop for the car", "stay to the right for the boda", "keep your eyes on the potholes", "stop chasing the chickens" and "look out for the cow" on a run. Even though I waited until the latest possible time tonight so it was cooled off, I still came back drenched in sweat and extremely hot. This swing in temperature is almost 100 degrees and I think will still take some time to get used to. My favorite part of the run is a road with really fine dust that reminds me of footprints in the snow. My shoes from running and my chacos (and my feet) are never going to be the same color again!) I am sorry about the foot of snow you all got back in MN…..can't say I miss it! 



This is the view of our apartment building from down the hill. It's still under construction, but it is very nice inside. I will have to post some pictures later. Out of all the places we have stayed so far this is probably one of the best, and most home-like of them all.

Tomorrow I am going with Renske to a children's prison - yes that's the correct term. I have been hearing a lot about it from her all week and I think it may be a little intense, but important that I learn about what happens to a lot of children who end up on the streets for various reasons. I may have something more interesting to say than stories about eating, shopping, and running tomorrow!




Tuesday, February 18, 2014

Home Again

I really can't believe that I am back in Uganda again!! I mean, I have been planning this since I left in August 2012, but it feels like it came up really quick. I knew that with the cost of a trip and the amount of time in my school schedule, I wouldn't be able to be back in 2013. It was the first calendar year in 5 years that I didn't go to Uganda, which was really, really sad. Instead I planned my schedule so that I finished the majority of my credits in the U.S. by February and then come here for the last 12 weeks of medical school to finish my electives, enjoy time with my Ugandan friends, and experience a longer time in this country that I love and hope to continue to work in. Prior to this, the longest I have been is 6 weeks. 3 months seems like an overwhelmingly long time, but I know it will be over before I know it!

I don't have a whole lot to say yet, as I have only been in the country for about 12 hours. The trip was uneventful and kind of tiresome. Although it is sometimes nice to travel alone, it can be lonely to not talk to anybody for 26 hours worth of flying and walking around airports. I had a few conversations with seat mates but I think I was so exhausted from the last four weeks of staying up late with friends and planning and packing that I just wanted to sleep. Let's be honest, airplanes do not make for good sleeping so I was anything but rested by the time I got here.

It wasn't until we landed in Entebbe that reality set in and excitement welled up. I felt like I had superhuman strength as I lifted my carry on (which is probably 50 lbs) form the overhead bin. It was the first time it felt easy to lift since the trip started over a day ago. Thanks to wanting to bring medical textbooks to give away along with the heavy electronics and some equipment, I had to overload my tiny bag to a weight nearly equal to my checked luggage. I always try to be inconspicuous about how heavy it actually is, but it is hard to hide a grimace and the struggle of lifting that thing above my head and getting it tucked away. Also, my struggling reminded me how nice it is to have a travel partner to help with all the lifting, but I will have those later on during this journey.

The next week I get to just relax and enjoy being here. Hopefully will be able to catch up with some old friends, maybe visit at least one of the orphanages, and meet some new people. There are many students and faculty from the University of Minnesota working at Mulago and I hope to spend some time learning from them as well. My official rotation will start Monday in Infectious Disease for 2 weeks. I don't know where I will end up after that. It's a bit of a mystery, but I know I will end up getting lots of good experience.

For now, I am just praying for guidance on where to go and what to do. It is nice, in a way, to have no real plans, but at the same time I like to have some things to do. I need to adjust to the heat a bit. I think the swing is about 100 degrees if you consider we had multiple days below zero and now the high's are 85 or greater. This Minnesotan will need to take some time to feel like the heat isn't going to make me pass out!

I will be staying with Angella, her friend and her son for at least the next 3 weeks and then possibly going to a more rural site in Kayunga. I will find out more of the details later. For now, the view is great. We are a little further outside the city so it is much calmer and quieter than where I have stayed before, but it is nice to leave the snow and wake up 30 hours later to this!



I will make updates as things happen. I can't promise it's always going to be exciting, but there is usually at least one or two things you might find interesting! I can't say I am going to miss the snow, but I will miss all the people back home for the next three months! Hope you all are enjoying the latest big snowfall!