Busy week!

I finally feel as if I have accomplished something as a volunteer nurse this week. I spent Monday in the Surgical Ward taking care of patients with a variety of infections. I have come to realize that other than Malaria, the worst thing for this population of people is wound contamination. It's very common for someone to have a minor wound, but because of the extreme poverty (no clean water, no showers or soap, no shoes, no diapers, etc.), bacteria invades these simple wounds, turning them into life-threatening chronic problems.


The routine is that patients present with an infected wound/abcess/broken bone/surgical site and they are admitted to Surgical Ward for IV antibiotics and then they go to the Operating Theater (as they call it here) for cleaning and debridement. Then they go back to the Ward for more antibiotics and a nurse removes the dressing each day, cleans it with Hydrogen Peroxide and cotton blobs and then re-dresses the wound. This can go on for days, weeks and months. Many, many patients here have come from outlying clinics, doctor's offices and hospitals after receiving "treatment", which means they were most likely infected with dirty needles and syringes and gloves, etc., which are re-used on multiple patients in some of the villages. One can imagine the transfer of bacteria and infections that develop from this.


I am not trained to be a Surgical Nurse...I like Pediatrics and Trauma, Trauma, Trauma! So, it was interesting to be thrown into the world of surgery and assisted with my first one. I spent three full days in Theater, operating with the doctors on everything from Stage 4 cervical cancer to many, many wounds and hernias, to delivering a baby c-section, a circumcision and removing cysts from various areas of the body. It was an experience, but I enjoyed following my patients during their treatment, surgery and post-surgical time.



This is the hallway leading to Theater. One drops their shoes and dons either a pair of community flip-flops or gum boots, which are knee-high white boots we often wear in surgery. Many nurses and Theater attendants wear flip-flops, which makes me cringe because of the potential a scalpel or needles or bodily fluids that can drop onto a person's feet and legs. Gross!












This is where we scrub up before surgery. They had soap, but no scrub brushes until I brought them with me from the U.S.

Aren't I attractive in my surgical gear? The white apron is plastic, which is very hot. We have no a/c here of course and the windows are open for breeze. This is the secondary operating room, used for those who do not require ether, which is the only method they have of inducing unconsciousness. The door on the left leads to the break room of sorts, where we eat lunch. If we are operating and need something, we call out to whomever is eating, about 10 steps away and they don a mask and hand it to us. This operating tables wheels don't lock anymore, so the patient often moves about while we are operating on them.




This is the second bed in the secondary operating room and anything from gynecological (note the very comfortable stirrups) to hernia surgeries are done here. The floors are concrete.

This is a 4 year old boy who presented Thursday with massive ascites. His growth is obviously very stunted and his belly is full of fluid. His extremities and features are quite swollen. The doctors suspect Nephrotic Syndrome.

Dr. Edward drained over 1 1/2 liters of fluid from this little guys belly.

This little 3 year old boy had a circumcision and when we were done, they put him on the floor, in the corner, while they performed other surgeries. He was still out from anesthesia and he lay there for a couple of hours, which really bothered me. I kept asking about him and was quite worried that he wasn't being monitored. He finally woke up and his mother took him back to the Children's Ward.

This is the cutest little boy named Joward who was playing football and fell and cut his leg. He's spent the last 2 months in an outlying hospital fighting the massive infection that invaded his leg. He has lost quite a bit of his muscle, but it looks a lot better than when he presented. He speaks no English, but for "Good morning Madamme". He's very sweet though and this morning I went to visit him and I put my Ray-Ban sunglasses on him and he looked very cool!

This guy was a real treat! He's been a very non-cooperative patient, who is also a prisoner, on the Surgical Ward and he says that his leg was "shot with syringe full of parrafin by the police". He speaks no English either, but told the other nurses he's going to file charges against the police for trying to kill him. We were trying to explain to him that wax would harden as soon as it gets into a syringe and that couldn't possibly be the case. As suspected, when we opened his leg up in surgery, it was just massively infected from his gunshot wound and no wax was found! Imagine that?









This little baby girl was born c-section on Thursday night. Her 17 year old mother had been in labor for more than 2 days without delivery and when we finally delivered her, the umbilical cord was wrapped around her neck twice and she was quite blue. She's going to be fne though, but I thought it was funny that they placed her in an instrument tray and put her in the other room, while they finished with her mom. She was a nice sight after a long, hard 12 hour day of surgery for me.




This guy was hit by a car while walking, in February and had his broken leg "repaired" by another facility. He came to us with a pretty bad infection, but did very well and was discharged yesterday. He was a very nice man.















This broke my heart. Robert, one of our wonderful doctors, asked me to assess this baby, after he noticed her lying on a bed of a patient's in the Family Ward yesterday. I unwrapped her blankets, which were soaked with urine (there are no diapers here) and found this. She's 6 months old and weighs 2.8 kg. (6.16 lbs.). Both she and her mother have AIDS and the mother has been very sick and her breast milk dried up. The mother told us that the baby developed diarrhea, so she stopped feeding her or giving her water more than one week ago!!!









Her name is Claire Favor and you can see the "baggy pants" that is the hallmark sign of severe malnourishment. I got her all cleaned up and got her some fortified milk (they use cow's milk, sugar and cooking oil) and she was so weak, she couldn't even suck a bottle.














I finally got a syringe and fed her milk, a drop at a time, several times yesterday. I went back last night to feed her after Theater, as it was clear the mother was too ill to do so. Each person in the hospital comes with an "attendant" who cooks for them and does their laundry, etc., so we taught the attendant how to feed the baby. I went back today on my day off and checked her, but she's very irritable, won't really eat and has a high fever, which is not uncommon with AIDS. Tragic.

My home "away from home"

This is the view as I come out my door each day. That street is very, very busy, as it is the only road that connects most of these villages. Boda-Bodas (motorcycles) sit out in back of my house on this street, waiting to taxi patients/families/staff to and from their homes.

This is the Kilembe Mines Hospital Guest House. It's divided into two...like a duplex and I live on this side. It has running water (can't drink it though, as it's from the river), a western-style bathroom (thank God!) and power that comes on from 7p-7a and again around lunch.

This is the front of the house.

View from the back of my house.

I have these lovely little visitors in my home pretty regularly. They scare the crap out of me and I have to get a broom and steer them back outside.

Sunday Dinner-Kilembe-Style!

The funniest thing happened yesterday. I had to get some things at the Kasese market, which is about 23 km away from Kilembe. Sister Theresa offered up the hospital's driver, but we had to swing by the convent and pick up one of their housemaids so she could buy some chicken for our dinner today. I was trying to buy matches from this guy so I can light my kerosene stove at home, but he kept trying to sell me cigarettes.

I finished at the market and got in the truck. I was in the front seat and asked the girl where the chicken was, as I wanted to see how their chicken is packaged. I have been VERY hesitant to buy meat or eggs, as I have seen them left outside in the heat and I really don't want to get sick. The girl said the chicken was there and pointed down to the floorboard. There was a live chicken! He was just sitting there, waiting for his fate. I was so shocked, because he didn't make a sound. The girl doesn't speak English so when I asked the driver what she would be doing with him, he drew a line across his neck with his finger, indicating she was going to chop his head off!

I felt bad and laughingly yelled at the chicken to "run for your life!" He didn't listen and when I went to Sister Theresa's today for Sunday dinner, he was on our plates!

This is Sister Theopista. She's the Deputy Administrator of Kilembe Mines Hospital and shares a house with Sister

Theresa. She has severe Malaria for this last week and this is the first day she's even been out of bed. She's one of the nicest and happiest people I know, so I was glad to see that she's feeling better and could join us for Sunday dinner.

This is the view I had as I walked from my house to Sister Theresa's. It's really very beautiful and most people have mango and banana trees in their yards.

This is Sister Theresa. She is so sweet and does whatever she can to make me comfortable and happy. I love her!

As probably happens with most volunteers to developing countries, this has been a week filled with frustrations.

On Monday, I was drawing blood from patient after patient and I guess I wasn't paying attention like I should have. I ended up squirting an entire syringe of blood on my face and all over myself while drawing blood from a child, for a Malaria test. I sent the child's blood, as well as his mother's blood, to the lab for HIV testing, but as luck would have it, there seems to be no record of the test or the blood and the patient has been discharged. I don't believe I ingested any, but it's still kind of scary. On a good note, I seem to be in an area of Uganda where there isn't much AIDS. I would guestimate that 95% of the children we see are here for Malaria and its complications, so I am crossing my fingers.

On Tuesday, I did a very dumb thing. Power is off here from 7 a.m. until after 7 p.m., but comes on briefly so we can prepare our lunch. I had my stove on when the power shut off and I didn't realize I had left a burner on. When I came home later that evening, my house was filled with smoke and soot, as my kettle had ignited on the stove and caught on fire and then extinguished itself. EVERYTHING was covered with black soot and I had to take the next day off, hire two people to help me and we scrubbed the walls, ceilings, floors of the entire house. The ceiling in the kitchen is still completely black, but it could have been so much worse. There are no smoke detectors, extinguishers or fire departments, so I am so lucky I didn't start the entire house on fire.

Thursday and Friday were incredibly frustrating and I almost packed up and flew back home. The Children's Ward has a patient count right now of about 54 patients and usually there is just one nurse for all these children. Eight of those children are critical, 38 of them are acute, but not life-threatening and the others would be what we in the U.S. might have in a "Step Down Unit". On those two days, we had NO nurses at all, but we did have instead, a young man whom they call a "Nursing Assistant", to take care of all our patients. Because I do not speak Lugandan and very few people here speak more English than "Good Morning Madamme", I can only wait until I am told what I can do to help. So, I wait.

We have a 9 year old boy who was post-op from a gut perforation from untreated Typhoid. He had been writhing and moaning in his bed all morning Thursday and I kept telling the Nursing Assistant that something was wrong with the boy and that we had to get some pain meds for him. I finally kept persisting (as I have been known to do) until finally that afternoon I pitched such a fit that he went to the doctor and retrieved some pain medicine for this child. I later found out that he hadn't had the first bit of pain relief since his surgery the day before! I was appalled! The next day it was more of the same and I knew something wasn't right. By Friday afternoon when I finally found a doctor to check him, he actually had feces leaking out through his incision site and had to be moved back to the surgical unit. I'm certain he's probably septic and his outcome may not be good, but I am hopeful and praying that it is.

The biggest problem is that there isn't a solution at hand. We have only 4 doctors to see all the patients who are hospitalized, all the outpatients, all the HIV/AIDS clinics, all the Outreach Teams and to do all the surgeries. Our doctors are young Ugandan natives that are dedicated to helping their people and do so for very little pay. We don't have enough qualified nurses and I did the conversion yesterday and realized that a nurse with a degree from a University, makes about $1585.00/year here. As the "Matron" or Charge Nurse says, it IS a sacrifice in this country for someone to be a nurse. They are overworked, underpaid and overwhelmed. We don't have enough supplies, because we don't have enough money. We don't have clean water when we turn on the faucets here and we run out of gloves every other day. If we don't have an item or a medicine needed for a patient, they must go to the "store" here and purchase it. The other day, we ran out of IV drips sets and the patient's family had to go to the store to buy it so their family member could get Malarial drugs.

I saw the worst case of Malnutrition I have ever personally seen yesterday. A 5 year old girl and her family were brought in by a Mzungu (white guy) who lives near them and wanted to help them with their plight. This poor little girl maybe weighs 20 kilos, all of her bones showed through her skin and all the fat on her body has wasted away to the point that she looks as if she has permanent wrinkles drawn on her forehead...like a costume mask. The worst is that with severe malnutrition, comes edema of the extremities and the skin can only stretch so far. She had many open seeping wounds between her toes and fingers, on her arms and legs and one on the top of her foot that was so infected, that I am sure once she is stabilized, will require surgical intervention. Her family lacks the education or money to bring her to the hospital for treatment. Unfortunately, I guess they didn't realize that no one is turned away here for the lack of ability to pay. They waited so long and now the child is critically ill. The man who brought them handed me 20,000 Ugandan shillings (about $10) and told me to see that they got food, because if he gives the money to them, he didn't think they would get food. So tragic.

On Monday, I will be in "Theater" (Surgery), which should be very interesting. They have a lot of trauma and surgical cases here, because people don't wear seatbelts or helmets. They drive like maniacs and there are no speed limits. Very few people have cars, so most are on foot, bicycle or boda-boda (motorcycle) and get mowed down pretty often.

Tuesday, I will be accompanying an Outreach Team to some of the surrounding villages. I can't speak to the patients directly, but I can be an observer and hopefully help in some way.

I will try to get some more pictures of the village and so forth posted in the next few days.

Christy