Updates

I can't believe how quickly the days can go by without me posting anything! So sorry for the delay. I really get exhausted by the time I get home from the hospital, even if it is a "short" day,  meaning we start by 9:30 and get done by 2:00 or so. The problem is, getting to and from the hospital takes a lot of energy, and standing and walking around the wards wearing a white coat stuffed with 3 books, thermometers, a pulse oximeter, stethoscope, and a bunch of random other things takes more energy than I realize. I mean, we do similar things at home, but we have air conditioning, places to sit down in patient rooms (or talk about patients in a room with a table before we actually go to see them as a group), and an unlimited number of computers to look things up on at any time so real books in white coats are nearly unheard of. I still want to talk a lot about working on the Infectious Disease ward, but every time I sit down to write about it, I get overwhelmed because in a day we see a lot of things that are intense and I am not quite sure how to summarize it all in a way that is respectful to patients, Ugandan physicians, and we "Westerners" here for our medical school rotations or staff doctors offering their "expertise" for the patients. Pretty soon I will try to get at least a few of my thoughts and stories down for you.

As for Rose, she is doing a whole lot better! She was gone at the FoodSteps home from Thursday until Monday, but since she had malaria, needed to be evaluated for malnutrition, and has to be watched a little closer than she could be at the home for the time being, Renske brought her back here. I have to say, it was quiet over the weekend without her. I mean, no, I didn't miss her peeing or having diarrheal episodes on the hallway floor or crying all night long, or her staring longingly at my mangoes every time I tried to eat, but it was nice to have the little lady wandering around.

Since she came back, she has made drastic improvements. I think she gained at least a pound in the first 3 days and since then has probably put on at least one more. Her cheeks (both on her face and buttocks!) are filling out. Her belly is still big, but much softer than before. The best part is that she is a lot more interactive than she was when she was initially here. She still gets extremely excited about food and has a temper when she doesn't get what she wants. For being so little, she can pack quite a slap when you don't give her the Plumpy Nut right away. By the way, Plumpy Nut is an amazing invention in the world of malnutrition. It is a high calorie paste-like peanut substance that kids generally tolerate really well. It comes in individual packets and caregivers are instructed to give a certain number per day in addition to eating normal foods as they are able. For those of you worried about peanut allergies, there is surprisingly very little evidence that the millions of kids that have gotten it to treat malnutrition have had adverse reactions, so we can be thankful for that! Lots of kids around the world have benefited from getting this awesome stuff when they are severely malnourished and have very little chance of getting access to high calorie food.

Renske does an amazing job with Rose, being patient with her messes and not tolerating any of the attitude that Rose throws her way. I am generally a sucker for big watery eyes, and Rose likes to stare until you feel sorry for her and give her what she wants. Renske has taught me that you don't give in to that and even though she is sick and in need of a lot of rehabilitation, that doesn't mean she can get away with bad manners.

Today, I woke up to a little hand opening my door and a giggling voice as she looked at me sitting up in my bed. She came in just to say hello - and she was SMILING! A week ago she would usually come if you waved your arm to call her over, but she was expressionless. She has made a game of finding random objects to hand to me and then I thank her for bringing me something. It makes me happy to see her smile and laugh.

Rose still does have some problems. For instance, she eats well but still has diarrhea, but it is confined to the times she is actually brought to the toilet rather than on the floor. Vomiting can still be an issue. When Renske pulled up to get me today, she turned around to look at Rose who had just vomited all over the back seat of the car (I think for people that have raised children, vomiting in the car is probably more common than I assume it is, so I guess that wasn't that big of a deal). Also, she sweats, A LOT! Anybody that knows the Perko family knows that sweating is genetic for us. My brother left every basketball game with a puddle on the court. When I come back from running here, it looks like I took a shower. When Rose does ANYTHING, she is drenched. It doesn't matter if she is sleeping at night when it is cool, riding next the the air conditioning vent in the car, or just sitting at the table. She ends up dripping sweat from her face. It might be from simply being weak and it being hot, but we still think she needs testing for TB and maybe some other things even though she was treated for malaria and dysentery. Hopefully she will get a check on Friday and we will find a reason for her continued sweating.

For now, we can rest assured that she is generally getting better. I have a couple of pictures from last week. I will maybe take some tomorrow to show you all how she is a lot happier and excited that she had been before. It's great to see the turnaround. As for her emotional health, I don't know how much we will know until she gets older. For now, we are just trying to give her a lot of love and pay attention to her, which seems to be bringing out more personality in her….and we have decided that she can be really stubborn!