It's a new year!

I haven't posted anything in a really long time. I have been sick with Malaria, traveled extensively throughout East Africa over the holidays and have just been plain burned out over what I see here. But...I only have a few weeks left and although some of these pictures are a lot more graphic than my last posts, I think people should see at least some of what I see.

This is Christine. I don't think you can see them, but she has about 1,000 bee stingers in her body. She was playing outside while her dad worked in the garden and was attacked. He brought her in barely breathing and unconscious.

I ran to my house and got her some Benadryl and we gave her some other drugs to help with her swelling and reaction. She did better and by the time I left that evening, this is how she looked. She was very swollen, but was sitting up and drinking sips of water with her parents at her bedside.

I came in the next morning and was surprised to find she had died the night before. I guess her little airway had closed up from all the edema and she couldn't breathe. It wouldn't have mattered if we would have intubated her, because we do not have a single ventilator here, nor do we have any respiratory therapists, so there really was nothing we could do. She was 3 years old.

This little guy was hospitalized for weeks with a severe case of Osteomyelitis. These all start the same...as a small wound that gets infected and the infection travels to the bone. They usually end up losing large pieces of bone and if it heals, it takes months. He did pretty well and ended up being discharged to home.

This little girl was in for a gut perforation. This is VERY common here, as the villagers drink untreated river water, which is contaminated with Salmonella Typhi (Typhoid Fever). It usually remains untreated and then causes their intestines to perforate and their abdominal cavity fills with feces. They get extremely ill, febrile and malnourished. Once they finally come to the hospital, we operate to remove the feces and pus, repair the holes in the intestines and then place a drain and sew them back up. It's not at all unusual for them to have multiple trips back to the OR for repeats of this procedure. Sometimes, they are too late and they die anyway. This little one was hospitalized for a long time, but eventually went home. Yay!

School lets out around the first of December and doesn't commence again until the February and during this time, MANY children present with all kinds of injuries. This boy is 15 and was pushed into the fire by his friends. They were just messing around, but he was severely injured. He was burned over his face, arms, legs, back and feet and required extensive debriding (pulling off the dead burned tissue so the good tissue can heal) and skin grafts. Skin grafts are brutal and require us to slice the top of a person's thigh with a razor and apply that skin to the affected site. I am sure it's very painful. This boy was hospitalized for a very long time and had repeated surgical procedures to repair "frozen" joints and grafts, but he eventually also went home. I think it's best when the kids are in school and don't have so much leisure time to be injured.

This is another case of a mom taking her child to an outlying "Health Center" for her immunizations and the staff there used either the wrong medications or dirty needles (needles are reused all the time to save money and increase the health center's profits) to give the injection. She presented with a severe abcess to her buttock and this required weeks of debriding, cleaning and then finally sewing her back up. She suffered through a lot of painful procedures, but eventually was released to home.

This is Brian. He is a "Paramedic", but here in Africa, that means something entirely different than in America. I would liken it to being a P.A. in the U.S. He specializes in orthopedic cases, but he and I do rounds every Monday/Wednesday/Friday on the Surgical Ward and we are in Theatre (OR) on Tuesdays/Thursdays. We often operate EVERY day, because it seems like there are always C-Sections or emergent cases that can't wait to be scheduled. Brian is one of my favorites because he is always pleasant, speaks the local language since he was born and raised here and is very kind to the patients and their families.

This case really infuriated me. This little boy was brought to the hospital 5 days AFTER he had been severely burned. We couldn't get the straight story from the mother, but we finally deduced after days of questioning her, that someone intentionally burned him...most likely her husband. She would never look at us in the eye and ignored most of our questions. There are no services in place where this type of injury can be investigated or prosecuted. They let it all go.

He was hospitalized for quite a while and suffered seizures and seemed to have some brain damage, but in the end, he recovered and went home.

I am hoping he doesn't experience more of the same type of abuse, once he's home.

As anyone can see by this picture, this bone is dislocated and displaced. This poor woman went to a local "healer" and they applied some sort of an herb poultice, wrapped tightly around the elbow and she was told to go to bed for a month.

This is how her arm looked once we removed the wrap. The herbs had actually damaged her skin, most probably permanently. We took her into surgery and re-broke and then repaired her elbow.

If she would have come to the hospital when this first happened, we could have popped that dislocation back in and she would have been immediately okay.

This is a little girl's hand after we had to amputate her index finger. She's fine now and was discharged later that week.

Her finger was so badly damaged, that it couldn't be saved.

This is one of my favorite patients I have had since I got here. His name is Steven and he's 70 years old. That's his lovely and very sweet wife seated there with us.

Steven came in for a hernia repair and complications developed. The wound got infected and he required a very long stay here until it cleared. He had several trips back and forth to Theatre to clean it up. He has a wonderfully supportive family who came to visit him all the time. He speaks great English and he came to regard me as a daughter. I loved taking care of him and was happy to see him get well.

Sister Theresa Kamugole and I were riding into town and I had her try on my "sun goggles", as she called them. I am pretty sure it's the first time she's ever worn a pair of Ray-Bans. I thought she looked great!

This is 19 year old Robert and his brother Moses. Robert was in a motor vehicle accident and sustained a wound to his arm, which of course, became infected. It progressed to Osteomyelitis and he was subjected every day while hospitalized to cleaning of the wound with burning Hydrogen Peroxide (full strength) and then having gauze pushed into the wound to absorb all the drainage. This went on for weeks and weeks, until we finally got it clean of all infection, it was re-sutured in the OR and he was finally released to home.

This is interesting. This is the "formula" that they use here to feed babies who are malnourished. It's a mixture of cow or goat's milk, sugar and cooking oil. It's used for those who are so malnourished and for whatever reason can't breastfeed. Babies are breastfed here for about 2 years.

This is the Nutrition Department. The man you see here is actually warming up some of that formula for me to feed the malnourished baby posted on my last blog. He has to build a fire and wait for the pot to heat up and THEN can give me a cup of warm milk. We have no stoves here with which to warm anything.

Just an update...Claire Favor, the malnourished baby from my last blog died. Her mother, who also has AIDS, told us she was tired of caring for her baby and they decided that it was the formula that was making her have diarrhea, not AIDS. So they tied knots in the four corners of her blanket to ward off the evil spirits that were making her sick and refused to feed her again. The last we saw of her, they were giving her black tea with a spoon. When I last weighed her, she weighed 2.9 kilograms, which is just over 6 pounds. She was 7 months old.

This 2-day old neonate presented with severe bilateral clubfeet. There is a great method to treat this and can be done with 7 castings and can be almost totally unnoticeable by the time the child is 3 years old. Because her wonderful mother brought her for treatment early, this child should not be disabled.

This is the baby of a patient being seen on Surgical Ward. I just thought she was really cute and wanted to hold her. It's great seeing children who are well taken care of here.

This lady was a frustrating case. She's quite obese, which I have found is VERY unusual here. She came in for a hernia repair and then the site got very infected. She ended up being here for weeks, as she would not assist in her own care. She refused to get up out of bed, wouldn't walk, wouldn't do her breathing or physical therapy exercises and just laid there. Her family and I begged and pleaded with her to try to help herself, but she refused. She wouldn't even move her arms. Eventually, she suffered a pulmonary embolism and died.

She came in for a hernia repair and died! Tragic.

This is an up-close picture of Eva's wound on her upper thigh. It's not so bad really, but it started as a small wound and as they all do, got very infected. This led to Osteomyelitis and her femur became very necrotic (dead tissue).

After weeks and weeks of cleaning it daily, packing the wound and dressing it, we took her into Theatre to close it. Minor procedure right? She was anemic and we couldn't get blood. She bled to death later that night. She was about 9 years old.

This is another view of Eva's leg. There was also a small wound on her inner thigh.

Ever since her death, we check the Hemoglobin level on every patient that is going in for surgery. If we don't have their blood in house, we no longer operate on them.

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

Kilembe Mines Hospital

This is my little buddy Joaquim. He's being treated for Malaria and is doing quite well.

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This little boy was very ill from Malaria, but recovered. He was one I thought may not make it.

This is how hospital linens are dried each day. They are washed by hand and then spread on the lawn.

The woman above is waiting for her baby to be seen by Nurses.

The little one in the middle is a patient in the "less acute" part of the Children's Ward.

This woman nurses both of her twins. One of the babies is a patient, but the other became ill as well.

These are patients who aren't as ill as others we have hospitalized. They just run around at will. They have no wristbands and it's impossible to tell who are patients or visitors.

I thought this little girl was adorable!

Believe it or not, these are twins. The one wrapped in the striped sheet was admitted with pneumonia but is doing quite well now.

This woman carries her baby in the traditional African way.

Families gather outside to bathe their other children, prepare meals and wait.

This is the 30-bed "sub-acute" area of the Children's Ward. It is very crowded and these children are rarely seen by medical personnel.

This would be considered the Pediatric Intensive Care Unit, if such a thing existed here. There are 8 beds and patients are very critically ill...most with Malaria and its complications.

This is the Nurse's Station for the entire Children's Ward, which currently houses about 54 patients. That is a nurse on the right and the guy on the left is Edmond. He's a clerk, but he is awesome with getting IV's on those who are difficult to obtain. I call him the "I.V. King" and he laughs.

This has been quite a week of overwhelming circumstances for a girl from a small town in Idaho!

I was picked up Sunday afternoon by Sister Theresa Kamugole and her driver for the long 7-hour drive to the village of Kilembe. En route, Sister received a call that the Head Priest at the Kilembe Diocese and Hospital had been killed in a horrible car accident. Since she is the Administrator of the Kilembe Mines Hospital and a nun, we had to go to Mubende, Uganda so she could prepare his body for viewing and burial. He had done much work with the Ugandan government and directly reported to the President of The Republic of Uganda, so was given a State viewing and burial. She was very distraught about this, as she has worked closely with him for more than 16 years and he was her "family". Sister ended up staying on in Mubende and I rode the rest of the way alone with the driver Patel.

I have been surprised to find that although most Ugandans who attended school learned English, it is still difficult for me to understand them. They speak slowly, use long vowel sounds and ennunciate everything so much, that I cannot understand them and they do not understand me. I repeat myself many, many times. For example, when they say the word "Africa", they say "Aff-ree-kah". Each village or tribe has its own language, so many Ugandans have language barriers even with each other. I liken it to Northerners trying to understand Southerners in the U.S. Although Swahili is more common in the larger cities, "Lugandan" is spoken here and is very difficult for me to grasp. There is a lot of tongue rolling and even though I can try to repeat something they are trying to teach me, I can't remember it for long. I am called a "Mzungu", which means "white person" and I hear many children say that as they are pointing to me in wonder.

Names are interesting because most people have two names...generally a very African first name, followed by one that to me, is surprising...like "Jennifer" or "Patrick". I'm called Christine usually, because to Ugandans, that is more normal than Christy.

The currency is the Ugandan shilling and US$1 equals about 1900 Ugandan Shillings. One is considered to be rich if one makes more than 750,000 Ugandan shillings/month, which is only about $350 USD.

They are such polite and formal people and although they stare at me in wonder since I am the ONLY white person some have ever seen, if I say "Good morning", I am always greeted with a "Good Morning Madame". Women ONLY wear long dresses or skirts and most men wear long-sleeved collared dress shirts and suits or dress slacks.

People get around on foot or by "boda boda" which is a scary motorcycle. Pigs, cows and goats wander all over the place.

I have been welcomed here hundreds of times and am repeatedly thanked for helping them, which brings me to my work. I started in the Children's Ward or "Toto Ward", as they call it and what an eye-opening experience this is!

This village lies at the base of the Rwenzori Mountains in southwestern Uganda. They have a tiny post office, one gas station and a few little shops. The hospital is both public/private, which means patients pay a small fee for services, which can cause a terrible burden on them. The hospital was built for 100 patients, but currently has a census of about 220. Meals are not provided and there is not adequate staff to care for the patients, so families are expected to accompany the patients and provide food and care for them. The families all sit outside in the compound on the ground and have to find a way, three times a day to bring a hot meal to whomever is inside. The hospital has a rudimentary space in the back where families may cook over a fire, but they must provide their own firewood.

There is no running water, only water that is brought in from the river, so it is of course, contaminated and must be boiled for drinking. Because of the difficulty of this, I believe that most here are basically dehydrated. Mothers or grandmothers nurse their infants, as there is no formula or bottles. No one has even heard of diapers and babies/toddlers who are not potty-trained pee/poop at will whenever the urge strikes them, so you can imagine the problems this can cause. Families must provide their own sheets and usually only have one or two, so if one is soiled, the other must be washed by hand, in a bowl, outside and then set out on the ground to dry. This happens many, many times each day and the children are usually soaked and so, I have not picked a baby up yet. Everything smells of urine, but there is no solution at hand. I brought in baby wipes today and you would have thought I had invented fire! I went from baby to baby cleaning them up and showing the mothers how and they were amazed.

The parents/grandparents seem to be very devoted to each other and most of the children have both parents at their bedside around the clock. The ones who aren't there are temporarily out caring for their other children or obtaining food/water.

So far, Malaria is the worst problem I have seen. The Anopheles mosquito is the only mosquito that can transmit Malaria to humans and because it is quite hot here year round, everyone's windows are open and the little buggers come through wherever they can. Everyone sleeps under a mosquito net. I'm getting quite an education about children with Malaria and this is basically what happens: The child develops a fever and within 24 hours, can easily be 104 degrees, followed by lethargy, listnessness, loss of appetite, dehydration, coma and death when untreated. The child goes from well to deathly ill so quickly, it is hard for a parent to seek treatment fast enough, before the disease is "severe". The parasites secrete toxins in the blood of the patient and that's what makes them so incredibly sick. Malaria can only be detected through a blood test.

The treatment for Malaria in children here is blood test confirmation, IV fluids of 5% glucose (that was odd to me, but upon researching this I found that the patient's blood sugar levels drop so low and will cause brain damage), oral or rectal Parecetemol (Tylenol), antibiotics and oral/IV Quinine. It's a brutal illness and I have 2 patients in my ward that look like they may not survive it. I haven't seen either of them conscious in 2 days.

There is so much more and I have many interesting pictures that I will try to post soon. I walk around asking people permission to take their pictures and when they say yes, I take the picture and then show them their image on my camera, which completely delights them. They love me for it now!

Thank you for all your support.

Much love,

Christy