Uphill then Downhill

Wednesday. I am tired. Several trips to the hospital during the night. One of the diarrhea kids is not doing well. Not too much sleep, but when I did it was heavy. Early to the hospital. When I was leaving after rounding, Gabriel, the night nurse, and I stepped outside and he paused, grabbed my arm and said "don't step there, it is a snake" and yes it was. Not too big and with a design. Gabriel threw rocks at it, hitting it several times, but is slinked under the storage container. He told me it is very bad, a viper. Yikes. I just hate snakes!

Went to Bor today to plead our case with the Minister of Health and the Director General to get the state to provide formula for the triplet family. They really have nothing, not in the sense of having nothing in the USA, but in the sense of having nothing in the Sudanese sense. Nothing is nothing. No cows, goats, no land. They had to borrow money to buy a chicken - as I mentioned the other day.

Minister of Health

We were greeted cordially and when we told our stories, and showed pics I had on my camera, they were amazed. They seemed really receptive to the government needing to provide social services (is there such a thing in South Sudan?) for them. I am hopeful. We did get formula to take back to the diarrhea kids. That will be helpful. I also purchased baby bottles. The second thing we spoke of was the leper colony. I think we will go on Friday. Both the Minister and the Director General were not informed of this group. Dr. Ajak has made a report to the government on this colony, but since these two are relatively new, they had not come across the report yet. We discussed things that they could provide. We will get back to them after our visit with a new report. I did invite both of them to come visit our hospital and see the work we are doing.

Then back to the hospital. About 5 minutes after we arrived one of the diarrhea kids (such a terrible thing to call them) passed away. I was shocked. I was actually preparing some of the formula we got in Bor. I am so sad. I am so sad for his mother who tried so hard to keep breast milk down and ORS (oral rehydration salts). We did everything by the book and with our resources. I believe he developed some aspiration pneumonia. We had started him on Rocephin. But his pulse ox was down. We did put him on oxygen but the generator must be on for this. The generator was on most of the day and had been turned off to cool down. It was overheating. A half hour was all that was needed. This is when the child died, during this half hour. Diarrhea is the number one killer of children worldwide. I am just heartsick over this. This beautiful baby boy with huge brown eyes. We have no anti emetics, limited antibiotics and only ringers lactate - which I guess is ok for someone losing their electrolytes.

He looked so good just three days earlier

I ran over to the hospital and the little guy was wrapped in a cloth. Nobody was around. When I unwrapped the cloth to get one last look at his sweet little face, They had bound his face with gauze wrap. They also bound this hands together and his feet, as is their tradition. Rebecca, one of the mama's that does the wash, and young Mary, one of the cooks, came in and placed him into one of the carrying holders that they use for babies. Then Rebecca put it over her shoulder and Mary wrapped the cloth around them, in their tradition. They then went to the mother and accompanied her to the land cruiser that John, our driver, had ready to take them home. It was horrendous to witness. They were all very stoic. I think I was the only one crying openly. Please keep them in your prayers.
C

Routine

Tuesdays are often routine days. Over the rush of Monday, not yet hump day, too far away to look towards the weekend. So our Tuesday was just "normal", as normal as can be in the bush in Southern Sudan. Continue with sick kids, dehydration primarily.

Life on the compound is routine. Each morning I wake to the sounds of chickens and a rooster crowing. The last rooster that kept waking us was eaten. I am not sure how long this one is going to last. But there seems to be other roosters that are growing, so I am afraid we are stuck with the alarm clock.

Mary & Mary  start the day

Daruka arriving to work

Mary arrives and I hear the clinking of her putting the charcoal into a tin pan. I know water will be heated for coffee in about 20 minutes. Time to think of moving. Up, dressed, meet with Ajak and Dr. Mike while we drink our coffee and talk about the day. Slowly the compound comes to life. The staff wanders in for their coffee, tea, breakfast. I see patients walking over to the hospital to get registered and get their names on the list.

Then hours of hospital stuff. I have gone over this nearly each posting.

Later afternoon brings us to a lull. We are usually done with patient care and are now focused on settling the inpatients, doing vitals, giving meds. The guys wander to the big tree in front of the hospital next to the road. A big chess tournament starts. There is yelling, dancing, chiding moves and lots of laughing. Many matatu's come by, all honking and waving and some even stopping. Hardly different from any small town.

Ajak contemplates a chess move

John & friend dancing after work

Watching John dance while waiting for a matatu

                         The mama's on the compound are winding down their day. The two Mary's (both cooks) are usually the last to leave. Roda and Daruka, the wash ladies, bundle up their things. Rebecca and Naomi take one last sweep of our tukels, making sure the floor dust has been cleaned up. Often they are humming a Dinka song, and often the others will join in from around the compound. It is soothing and a sign of friendship amongst these hard working women. It is a sign that our day is winding down. I say wo be yook miak to each - see you tomorrow. They love my attempts at Dinka and giggle as I try to say phrases to them. They are beautiful people.  

Mary leaving for the day

Checking the patients before calling it a night

Our nights consist of gathering for dinner, and visiting. Then we often get on line, I write on my blog, others do their email. We often end our nights with some songs, Aaron plays guitar. I am trying to talk him into some Led Zepplin, Jimmie Hendrix so far no go, but he is entertaining the idea. Few chords of Layla this evening. He's learnin'. Great kid. So is Matt.

The night ends with reading in my mosquito net cot on my kindle - thanks Dave. It is a great thing. And I wind down listening to the sounds of the night, the compound settling down. People wandering to their cots and tukels, saying good night as they pass. It is peaceful, an oxymoron for Southern Sudan.
God's peace,
C

Just another Manic Monday

Started with a bang. Lots of patients waiting by the time we arrived between 8 and 8:30. Many sick kids. So the day was spent starting IV's, rehydrating little ones and cleaning up poop and diarrhea. I love my job! They are all so darn cute I could just squeeze them to death. We also have one adult, a woman, who is pretty depleted of all fluids. So we are pretty full up.

Waiting in line

So beautiful but sick

Mama worried

The three stooges are doing great. They have even been a little bit boisterous when they don't get their food right away. Mom seems to be doing ok, moving around fairly well. Did I mention that these three are number 6,7 and 8 in her household. She only has one girl. I think Dad is shell shocked.

Mom, Dad and the three

It is late, have just come back from the hospital. Just a short note for tonight. We will have to go to Bor to see the Minister of Health to get some formula for this family. There is no way they can afford formula for three kids .I found out they had to take out a loan to buy a chicken so Mom could have some protein. We insisted on this. I hope we are able to convince the Minister of the need for this family. Ahhh, the needs of everyone here are so great.
C

Lazy Sunday

Triplets doing well

The good news is that the babies were all still doing well this afternoon. Nurse Peter said he had a busy night. He took to feeding the three stooges every few hours, giving Mom a break. I fixed up a toomey syringe with lactated ringers and dextrose. Nurse Peter has named the three Michael, Ajak  and Khor Peter after the three attending men. Khor means lion and is nurse Peter's Dinka name.  He even put bracelets on to identify them. I don't think the Mom has had much to do with this. No girl, no Catherine.

Sitting in the back at church

Went to church this AM. It was great. This afternoon I went to Peter Kuchcorn's tukel. It was so cool inside. These Sudanese are on to something with their construction design. They are probably the same design since the time Christ walked this earth. We all spread out, put on music from Ajak's computer, read, visited, drank warm pop. Can't think of a better Sunday afternoon.

Peter Kuchcorn

Relaxing in Peter's tukel

Aaron chillin' at Peter's

This next week will be full. I think we will be discharging the burn guy - Malik is his name. I will be teaching his family how to do dressing changes. We will visit the leper colony probably on Wednesday. Dr. Mike has a connection to a Swiss group that takes care of lepers. We will go on a fact finding mission as well as hold a clinic, and then make a report to send to this group. We are also working on a list of medicines and inventory and what is needed immediately. There is also a  need for such basic things as gloves, gauze, 20g IV's. Somehow we will get by. Always seem to.

Happy Sunday to all.
C

I don't know nothin' bout birthin' no babies

OK, easy day. Few patients, some inpatients, and of course our burn patient. So an easy day. Spent the day going over solutions to get meds for the hospital. Working with Dr. Samuel of Bor State Hospital. He also is a Cuban Lost Boy and colleague of Dr. Ajak. Hopefully we will get some info soon and have a source of meds.

What a miracle

Dr. Mike with #3

This afternoon, after 3pm, a lady in labor came in. She delivered at home but was very obviously still pregnant. So we took her into the OR and watched as the labor progressed. Sure enough, baby number 2 came. He is really cute and appeared to be doing really well. So two boys. While waiting for the placenta, I said to Dr. Mike and Dr. Ajak "I think there is another baby, here is the head" and I was pointing to her upper abdomen. No its two placentas. Hmmmm. Anyways, placenta came out and baby boy number 3 came out. He was flaccid, not breathing and not a good heart beat. Dr. Mike went to town with compressions, I grabbed a mask and got the compressor on, we put a mask on and actually did some breaths into the little thing. He is probably a kilo (2.2 lbs), kilo and a half. No more than that. We did the stimulating and rubbing his back. And he had agonal breathing. Then he did better with the mask on. The compressor only goes to 5 liters, but it was enough. Thank God we had the generator on. Pretty soon he perked up, and started to breath on his own. After awhile he opened his eyes and tried sucking. We have tucked the kids in with their mom and grandma's and the traditional birthing lady who showed up to help. I am not sure they will all make it, but because of this hospital, they will have a good chance. Please keep them and their mother in your prayers. I guess I can help with this birthin' baby stuff.

Three little peanuts

God's peace to all
C

Friday Night Light

The moon is nearly full and the light it gives is unbelievable. Like a bright lamp up in the sky. I have to put something over the head-end of my mosquito net to keep the light out of my eyes so I can sleep. It is really beautiful.

I saw my first really big snake. I don't want to see another. It was going across the road. Dr. Mike and I were coming back from Werkok. Of course I am looking the other way and Mike stopped. I said "what" and he is just pointing. I was this close to expiring with the big grabber. Another exciting moment in Werkok, brought to you by Dirty Pants.

A group of people stopped by from Samaratin's Purse. It was fun to show them the hospital. They really liked it. I am so glad that I cleaned this morning. Gave a good impression. It is always nice to have visitors and to hear their stories. Last year on my way over here, I sat next to the mother of one of the girls who visited here today. Small world stories abound.                                                                                                  

Meeting friends on the road to town

Sign outside of the municipal office

Naomi's home

Kids can always find something to play with

We walked to Werkok for a cold pop early evening (see snake reference above). It is amazing how many people I now know. Felt a little bit like home when Dr. Mike said "do you know everyone?" I was crackin' up. It is fun, and hardly different from home - families trying to make ends meet, playing with their kids, loving their family, just trying to give them the best life possible. No, not too different from what any of us want.
C

Bor here, Bor there,

Dr. Cooper talking with Dr. Ajak

Ajak is in Bor at Bor Hospital attending an education seminar and getting CEU credits. He is working with Dr. Warren Cooper - who has worked with Dr. Chupp, Dr. Dan Stephen, Dr. Lim, etc. from Southwest Medical Clinic back home. Such a small world. He knows all those guys. Yesterday I took the burn patient to see him, for an opinion on how it is healing. He said that it looks really good and to keep up the same routine. I will continue to debride every day. A few more days ought to be all that is needed.

He is so sick, not much could be done

Then today John Makach, our mechanic/driver, took me to a neighboring village to find a boy with a heart condition. We were to take him to Bor Hospital so Dr. Cooper could do an echo cardiogram on him. They were suppose to be at the hospital on Monday but did not show. So John and I went looking for him. We found him in the hut of the traditional healer. She had made slices on his chest to bleed out all the bad. It was really sad. He is so pathetic. He is 10 years old, weighs about 40 pounds (maybe) and is skin and bone with large joints. His knees hurt so bad he has difficulty stepping up. His breathing is shallow and at a rate of about 36. I felt so bad for this little guy. We got him to the hospital and Dr. Cooper did the echo. It was very painful for the boy because of the burns on his chest. He was very brave though. Unfortunately, the bottom line is he needs a transplant. If it had been a mitral valve, Tenweck could have repaired it. But the ventricle was not moving. He has lots of problems with the heart. His name is Aluang Kuong, please keep him and his family in your prayers.

Traditional Healer's tukul

Our trip to Bor today was crazy! We got a little rain last pm. But closer to Bor, they got lots of rain. The roads are pure slippery mud. We might as well have been on ice. John did a great job, not getting stuck. It is easy to see why the road are impassable during the rainy season.

Hope all is well with everyone. Lot's of snow?
Love, C