Halfway to touchdown!

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Today, and almost down to the hour of this post (in Africa not those still sound asleep in their beds back in Canada), marks my halfway point until I land back on Canadian soil. It is so hard to believe that I have already gone through half of my trip and have half to go. There are so many things I have done and seen while in this country that my blogs will never capture. It is hard to believe a life beyond this place as well. I have loved living here. The trials, ups, and downs that I have experienced here have been so amazing. Life back in Canada just seems so far away and...I just so simple to life here? I do not know how else to explain it. Working in the hospital 4-5 days of the week have shown me that everything single day in this country is a struggle for some. They do not have a health care system that provides everything but some drugs for free, some of them don't even have water to drink once at home. It is hard to think that in a short 48.5 days I can experience an abundance of everything yet again. After saying all this that does not mean I am not excited to go home. I am finding myself actually quite homesick for the first time today. I am missing the simple things Canadian life brings, the comfort of my loving partner and our comfortable home (with two crazy cats running around), and seeing familiar faces again. I am also excited to not be a celebrity and to blend in once again.



Last week marked my first "week" in the Mbarara MUST hospital. The week did not go as planned unfortunately. Finally got a bit of a stomach bug and then hit a day later with a common cold (that came paired with an oh so lovely fever). Luckily I am on the mend and feel I will be able to face a full week of work next week and the 5 to come after! My first week consisted of only a few days but even in those few days I learnt so much! The major illness or disease state I will be dealing with while here is malnutrition in children. The nutrition centre I am working out of is actually built beside the peds ward for a very specific purpose. Most health facilities here that have a nutrition component to them have this same grouping. The rates of malnutrition in Uganda makes it an epidemic. Most children here will be in some sort of stage of malnutrition at one point in their lives. Here in Mbarara we are a referral hospital so we tend to see the worst of the worst and the set up reflects this. We have the pediatrics ward which has 4 different sections to it. There is the general peds who are admitted, acute, critical (those needing oxygen), and critical malnutrition. Every morning I start my day in critical malnutrition and weigh the 6-10 babies who are in a critical state to see if their edema has gone down and if they have successfully gained any weight on our feeding plan, which consists of feeding (usually) 60-70mL of F75, which is a feeding formula here. If the wee ones are doing great and have a stable weight for 3 days then we shift them to the nutrition centre as they are deemed to be out of the woods, medically speaking. Here in the nutrition centre we do more counselling with the parents (we do this as well down in critical but not always to the same level because we are more worried about them stopping breathing, or developing new symptoms). Here they are also switched to F100, and after they have gained some more weight (that is not edema related) we start to explore eating other foods like porridge and other items. Once the babies can start keeping this food down they are usually discharged. After discharge they are to come back every 2 weeks for a follow-up. This follow-up ensures the babies are still doing okay and do not need to be readmitted. We also get to do this really fun thing called an appetite test. We take this peanut paste (that apparently tastes like Reese's peanut butter cups) and try to see how much they can eat (we have guidelines so they do not over eat this stuff too). Watching babies eat it is sooooo funny. It is so mushy so they just mash it into their faces and get it everywhere. Plus it is super sugary and yummy so they try to lick up every bit of it. Watching their eyes bug out on their first taste is my favorite part of the day.



I think this first week of work also showed me how sad the situations here can be. We already almost lost a couple babies this week due to the complications malnutrition can bring but luckily we did not have to report any deaths. One of the major complications we have trouble facing is their weak hearts and lungs. We have a limited supply of oxygen tanks here and when we have a couple kids crashing we kind of have to pick who gets the oxygen and who doesn't. On Thursday we had this situation occur but luckily both kids were stable enough that we could switch the oxygen back and forth between them every few minutes. Certainly not ideal but it kept both of the kids alive until we got them into ICU where more oxygen was available in a more dependable way. There is one little girl I hope to still see on Monday when I go back to work. Her name is Prossy. She is less than a year old and the cutest little girl ever. She looks like a little old lady until she cracks a smile. It just lights up her whole face, and she looks young and careless in those moments. She has fairly severe spinal bifida that they cannot operate on as her weight is way to low. She has apparently been here for a month and has made very very slow progress. She started having issues with her heart and lungs this week which alarmed the staff. They really want to transport her from the nutrition centre to the critical malnutrition ward so oxygen supplies are closer but the mom won't let us. Due to the language barrier I had no idea why the mom wouldn't want to switch places if it meant her little girl would have less stress on her body. This mom has already had 5 children die in the past due to complications related to malnutrition. I then found out Prossy has TB, and I thought this was maybe the reason. The mom did not want to expose more people than had already been exposed but nope. The real reason was the mom simply did not want to move down there because the babies all have to double up on beds and then there is no room for her to sleep down there. I was completely shocked and felt I missed something. The head peds doctor put it into a very blunt perspective for me. She has already gone through the pain and loss of five children before, she is still able to reproduce, and so the sad fact of the matter is if Prossy does pass away another baby can be on the way in 9 months. Reproducing is like a culture here. You keep going and going until you can't. You also have to realize that the likelihood of them all surviving to adulthood is slim, especially when you are from the slums like Prossy's family is. It is a vicious circle that just keeps on going. I guess several of the kids we have in the critical ward are from the same village as Prossy. The peds doctor said they go and try to do training days in that area a lot and try to educate the parents when they come in to get their children treated but nothing they have done so far has really helped the majority of people. The best we can do is help the kids as best as we can, provide them the food while here, and enough food rations to hopefully get them out of the woods when they are back at home. Everyone is so passionate here about their jobs that I really do feel like we are making a change. Everyone is so motivated to help the patient as best as they can and in anyway that they can. It makes me excited to be a part of it and to also hopefully save some kids while I am here through my advice and training. So I guess overall is it sad, but it doesn't feel hopeless. No one has given up yet.



Not much else has happened this week for us. We did celebrate Canada Day with a good old fashion BBQ that I heard through my bedroom window as I laid in my bed trying to break a fever. We managed to go to the Central Market on Saturday to get our food for the week and Sunday has been a slow, cloudy day. This week promises to be another challenging one and we will finally meet up with the rest of the Canadians who are still in Rugazi. We have planned a weekend trip away together that I am excited for! Stay tuned for photos of me sitting on my butt in front of a beautiful lake possibly with a glass of wine.



Sending love from Africa for 48.5 more days.

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