Monday, September 17, 2012

Title 1

Panorama from the water tower at Nyankunde. How can such a beautiful country be such a mess?

We made it!

We made it back to the USA. Entebbe, Addis, Washington DC, Charlotte then back up the misty mountains to Boone. I think that international travel must take years off your life. Still everything worked out well and for that we thank God. Below are a few pictures taken around Entebbe. The Botannical Gardens are stunningly beautiful.

Friday, September 14, 2012

Waiting for the boat...

Well, we have said "goodbye for now" to our future home in DRC.  Warren keeps talking about the "cultural adjustment" that I am experiencing.  The concept of time in Africa is simply different and revolves around value and relationships.  I have "known" this.  It is one thing to "know" this and another to "experience" it.

We took the long way back to Uganda from DRC, actually a 2.5day trip by road and boat.  It is possible to simply fly (1.5hours) from Bunia, DRC, to the airport in Uganda but we wanted to "experience" life a bit.  We have wanted to understand how people get around and the landscape a bit.  It may not always be possible to take the ground route into and out of DRC, but it is fun.

Here is an outline of our day leaving DRC...the stops and all.  We woke up early in hopes of catching a public boat across Lake Albert at 9am to reach Uganda.

  • 5:45am-Warren wakes up
  • 6:00am-Lindsey wakes up (usual pattern)
  • 6:30am-Drinking coffee & waiting for the taxi

  • 7am-Still drinking coffee....
  • 7:30am-Still drinking coffee.  Our friend arrives to say that the arranged taxi is "not going out today."  He leaves to find another taxi.
  • 9am-Taxi arrives to depart for Lake Albert (2.5hours later than anticipated)

  • 11am-Arrive on the shores of Lake Albert after quite possibly the roughest road I have ever been on.  It would have been difficult to mountain bike on this road!  
    • Immigration officer told us the boat "just left."  He says that we might be able to get a pirogue across the lake; he cannot stamp our passports until we have plans to leave.
    • We see a motor boat approaching in the distance.  We both think: "This might be the way across the lake."
    • We descend the hill to check it out.
  • 11:30am-We makes plans to get on the motor boat $20/person.  We are thrilled!  Our bags are loaded.  We are told that they will simply have to offload a part of a crane before we can leave.  We talk to a health inspector and various other people, then sit down to wait.  We watch some young boys fishing in their underwear.
  • 12pm Back to the Customs Office to have our passport stamped.  Warren deflects a request for money by saying that he will be a doctor at Nyankunde in a few months if the border patrol has any medical problems.  The border patrol asks to see Warren in private about a health concern and forgets about the request for money.  The exam is conducted behind closed doors and results in a little smirking afterwards, also the use of hand-sanitizer.  Also an explanation of how diseases are transmitted from one person to another.  
  • 12:30pm-Other boats arriving.  Unloading of boats.  Men from our boat are nowhere to be seen.  We are told they are waiting for a battery to run the crane, in order to unload the boat we will take.
  • 1pm-Waiting for the battery to arrive.  Warren takes a nap with the guys.  Lindsey talking a young Congolese about the "Big Fishing Season" on Lake Albert in September.  The boy asks Lindsey about "Big Fishing" in America.  Lindsey struggles to explain why we don't eat big fish, due to toxins in the lakes.  Warren tells Lindsey NOT to try to explain how Americans prefer to hang their game fish on the walls (this would not be understood and thought to be ridiculous).  

  • 1:30pm-Someone starts up the crane.  This looks promising....
  • 1:40pm-Unload complete.  Men disappear again.  What is next?
  • 2:15pm-Men reappear and we load the boat to cross Lake Albert (about 3 hours later).
  • 2:15-6:15pm-Crossing Lake Albert.  Stunning sunset.  Warren drives the boat for a bit, resulting in a serpentine course across the lake.  Pirogues are still crossing the lake.

  • 6:30pm-Customs on the Uganda side.  Phone calls to the border patrol who has gone home for the night.
  • 7pm-Taxiing across Similiki National Park for Fort Portal.  There are warthogs, antelope, and baboons crossing the road.
  • 715 pm.  Stop to fix a tire.  Lindsey uses the facilities (bushes) and is nearly left behind. 
  • 9pm-Arrival in Fort Portal for the night.  We stayed at the Raja Excelsior Hotel.  Not quite as fancy as the name, but adequate. 

We crossed Lake Albert about 5 hours later than I "thought" we would.  I found myself frustrated by this and reflecting on why.  I concluded that I simply like to know what the plans are, to have some certainty.  Rather, the "certainty" was that we were on a journey.

After all that, we still don't really know when the public boat departs on Lake Albert.  Is it 7am, 8am, 9am, 10am?  Is it everyday or only Mon/Wed/Fri?  No one could really give a concrete answer.  The answer was simply that the boat does not leave everyday and that the boat usually waits until it is full.  This is Africa isn't it?  We both concluded that this is a fun adventure, just as long as there is not a flight to catch!

Well, we leave tomorrow for the US.  We hope you have enjoyed our little adventures.  Many more to come....especially as Lindsey gets "culturally adjusted."


Lindsey (for both of us)

Wednesday, September 12, 2012

Almost done

Almost done!

It is our last night at Nyankunde. The last week has been tiring. Lindsey caught some horrible virus which caused her nose to run like a faucet.  I had to give blood to a lady who was bleeding to death.  Normally I don't even notice it, but it seems like I've been huffing and puffing to get up the hill. The running has been on hiatus, while I try regenerate some red cells.

Lindsey and Dr. Chantal
OR #1
We've been working hard in the new building. We brought over a whole bunch of boxes from the old store room where an army of small critters was having their way with precious medical supplies. We found some great stuff, as well as a lot of things that we'll never use. The challenge has been to go though these boxes and separate the wheat from the proverbial chaff.  The chaff includes materials for open heart surgery, some chest tubes which expired in 1968 and an implant designed for surgery on the super-obese (not many of those around here.)  It has been tedious to go through all of this stuff, but it's simply something that has to be done.  Lindsey and I have different organizational styles.  Sometimes I need to find her a job like organizing the suture.  It is mystifying and a bit frightening to see how much she enjoys this.
Lots of suture to organize!

The new OR/ICU building is not exactly ready for prime time, but it's come a long way.  My pride and joy is the Endoscopy room.  We actually have a pretty decent collection of scopes and I have carefully arranged the room with the necessary instrument to peer into the various dark places in the body.  I also found an old table that we were able to salvage and repair.  I have named the table "Lazarus".  We have materials in the other rooms and equipment that is ready to be used.  When we return to the US, we'll be trying to assemble the material that is still needed.
Omviti and me clowning around!

We'll also be putting together some supplies that we will need in the next couple of years.  We will be hosting visitors in our house, so we're looking to purchase bulk food items.  Packaged food is quite expensive to buy locally.  As an example, a small can of oatmeal costs about $5.00.  I went online and purchased a 50lb bag of oats.
"Sir Leaksalot"

In addition to organizing the new building, we continue to deal with clinical challenges.  Today I re-operated on a patient on whom I'd done an ileostomy when I first arrived. His ostomy was putting out so much fluid that we just couldn't keep him hydrated.  I ended up calling him "Sir Leaksalot."  He was getting so malnourished that I feared we were just going down the slippery slope.  I sewed his intestines back together today.  Hopefully he will make it.  I also operated on a poor little girl who fell in the fire after having a seizure.  This is a tragic, but all-too-common story.  I did a skin graft on her face.  Lindsey has been dealing with sick patient and continues to struggle with kids who die from diseases that should be treatable.  They just come in too late.  It is heartbreaking to have a child die of malaria right in front of your eyes, but this happens.  It is a difficult transition to come from an ICU setting where everything is available, to a place where you often can't even get blood.  It will be a great challenge to see what is possible with the limited means available.
On the water tank

My guys
Last week was the 10th year anniversary of the massacre and destruction of Nyankunde.  Not much was said to commemorate the event.  It may be that it is too hard for people to think about it.  Still, it seems like a new day is dawning here.  There is a spirit of a renewal and a hope that things will be better.  The new building is a huge encouragement.  For Lindsey and myself, we are just happy to be a part of what God is doing here.  It is pretty clear that He has chosen this time for the hospital to grow and to strengthen its spiritual ministry.  It has been a tremendous privilege for us to be here and we are excited to return in January.

Tomorrow we will begin an adventurous return to Kampala.  We will take a vehicle to Bunia and then to Kasenyi.  We are planning to take a local boat across Lake Albert, then find a bus back to Kampala.  We're not sure how long this will take.  We have allotted a couple of days for the journey.  We could just fly, but I think it will be more interesting to travel using local transportation.  More on this later, if we survive.
Lindsey with a preemie
Obligatory sunset picture. 

We will return to the US for a bit.  I will be attending an orthopedic conference in Washington.  In mid-October, we will travel to South Sudan to assist with a medical project there.

As always, thanks for your prayers and your encouragement.

Warren (for both of us)

Wednesday, September 5, 2012

Panorama of the new building

Here is a view around the hospital. On one side you can see the new building. The other side is the view as you walk down between the old wards.


Tuesday, September 4, 2012

Week #2 Nyankunde

We hope that you are enjoying our photos and stories from Nyankunde!

It has been a very profitable time here, a time of learning a new medical system, all set within a very personable culture and language.  We are living in a village where there are no local stores-rather a local market, dirt roads, plenty of houses, and a hospital.  We are surrounded by green hills as far as the eye can see.  Every ridge is farmed.  Nyankunde is a little hamlet of a town amongst the palm trees, a place that has historically been a place of healing.  It feels like a privilege to be here.  Voila notre maison (here is our house).

The yard says "Bon Samaritain"

How can one describe the immersion that takes place?  Suddenly I am conducting rounds in French (or doing my best to), looking at my own ultrasound, examining a child's urine under the microscope, trying to determine the many causes of jaundice in this place, and how to best use rare resources.  There are many children with malnutrition here, and several without parents.  I diagnosed and am treating my first case of pellagra (vitamin B3 deficiency), countless cases of malaria, and even saw a girl with (what I believe to be) a rare autoimmune disease.  So much of diagnosis depends on the physical exam and clinical evolution, not lab tests.  It is a paradigm shift and something to get used to.  Yesterday I was at a child's bedside when the child stopped breathing, and I had to decide on an appropriate intervention.  In the US, I would not think twice about resuscitation, but I had to really think about what supportive interventions were possible.  The medical challenges are many, but it really is rewarding to see children improve. 

Omviti learning the hoyer lift

Other things...Warren is tinkering as usual.  We have almost installed a solar hot water heater on the house.  Our house will run completely on solar, with the exception of a propane stove!  We have been taking showers literally under the stars the last few days.  I told Warren tonight that we should install an outdoor enclosed bathtub for bathing!

We have been running together in the evenings...up and down the airstrip.  It feels good to run again...but will be better when we can take our bikes out as well.

Setting up a new OR building and ICU is a BIG job!  We are really hoping to get things organized and clean, ready to use the facility in January.  I have reviewed my surgical instruments and concluded that there is a retractor for every purpose.  

Brand names are important.  Case in point: "John Dear"

Nyankunde Hospital is behind us hidden in the trees
 The big excitement tomorrow will be the planting of our garden...stay tuned.  Love that "John Dear" wheelbarrow!