The End of Mbarara

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August 3rd 2016
Published: August 4th 2016
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Two weeks have passed since my last entry, and exactly two remain until I hop on the plane back home. I have felt unwell as of late, and my energy is at an all time low, hence the neglect in keeping my writing updated…

I spent the last couple weeks between the hospital and doing community projects. The community work included first aid training, which Dayna and I taught to a group of “paravets” – community workers who are trained in veterinary services to assist the goat keepers. The Vets Without Borders had organized an education day for the paravets, to refresh their skills on vaccinations, deworming, spraying for tics, etc., and asked if we could organize a component for human health as well. It was well received, the paravets had many questions and the presentation lasted over two hours. We talked about wound care, choking, burns, hygiene and infection prevention, signs of fever and unresponsiveness, and signs of when to take children to the hospital. They were grateful for our time and it was all in all a successful event. We also had fun helping with the goat training; each paravet was assigned a goat to lead through the different stations – Dayna and I assisted in identifying, photographing, and documenting the goats. It was all a little chaotic and a lot of fun. The goats being treated were the ones that were to be used in the goat pass off the next day. Goat Pass Off is where new members of the project receive two goats. In order to receive goats, they must meet certain requirements (such as having a locked enclosure that is raised off the ground, with access to food and water). The vets invited us for this event, so several of us joined to watch the brief make shift ceremony and to help hand out the goats. There were 58 to pass out, so it was another chaotic and fun filled day.

The following week we spent two more days in the communities. Monday we went to a school where the vets had organized a reusable pad day. Most girls and women here are unable to afford disposable tampons or pads, and going to school for that week each month can be a challenge. I was appalled to find out that girls here receive a 1.5% increase to their grades to compensate for this fact. The men argue that they should be happy and the grade increase is a good thing, but my personal feeling is that women should be empowered to never have to miss school for this reason and hence wouldn’t need the grade point advantage. I argue that we are every bit as smart as men and to be given such an advantage is demeaning. At any rate, the reusable pads are a movement to help address this problem, and with the help of organizers and sewers back home we were able to provide 71 sleeves to the girls. We demonstrated how to make new liners for them, and how to clean for and care for them. It was a good day, and I hope we inspired them to stay in school and work hard. The future only gets better when we are educated, and countries can only progress when women are empowered and provided the same opportunity as men.

Wednesday was the Nutrition Education day in Kishuro village; the vets had noticed many badly malnourished children in their work and asked us to organize an event to help address the issue. The nutrition students took the lead on this one; Dayna and I were to provide first aid training but the session lasted almost the whole day so we decided to forego the first aid bit, and offered blood pressure screening instead. Ian and James provided a cooking demonstration, in an attempt to bust the belief that men don’t cook. They made us a vegetable stew and a nice avocado salad. The nutrition students provided a lot of information, and answered a lot of questions. There are some pretty strange myths that hopefully they were able to dispel; I think they really made a strong impact and a few people told us they were going to change their eating habits. One of the myths I found amusing is that fruit is only for babies and children. Another myth that really chaps my ass is that it is bad for women to eat eggs or chicken; there is no logic to this, and the reason for the lie is simply so that there is more eggs and chicken for the men to eat. Oooooh Uganda. I think the most important thing the nutrition students could teach is how to properly feed children, who are generally given the same foods and ways of eating as adults. That is, they take a small, not very nutrient dense breakfast, a carb dense lunch, and a large meal for supper. The nutrition students encouraged the participants to give their children food more frequently throughout the day, with proper portions of proteins, vegetables and starches. In Canada we take for granted the knowledge we have about how nutrition affects growth and development, and so here we attempt to impart that knowledge to those who will listen.

Work in the hospital has come to end. I spent the last two weeks on the surgical ward, and was also able to pop into the surgical theatre to observe a few procedures. I find operations as beautiful and horrific as birthing. The most fascinating procedure I watched was a pyloric stenosis repair on a month old. It is unnerving to observe the effect of anesthesia on people, particularly on ones so small. They become so still, corpse like. Which, of course, is a very very good thing; to imagine procedures performed without it is gut wrenching. Like a nazi science project. The surgery was performed with great care, with tiny incisions for a tiny little body. The surgeons carefully cut and cauterize their way through each delicate layer of skin and what little fat there was left on the malnourished baby, slowly gaining access to the viscera within. Once through, they pry the flesh open with their metallic tools, creating a new orifice from which to extract the infants’ tiny pink stomach. So tiny and delicate, fresh. They remove the malfunctioning organ from the safety of its cavity to the external world, displayed now on the lower abdomen. Once there, the surgeons begin to work on the valves that caused this baby its extreme malnutrition. With tiny tools and incisions they skillfully conduct the repair. When the work is complete, they poke the stomach back through the temporary hole, back into its’ home where it will now be able to function properly. The edges of the flesh hole are propped open wide, resembling a gaping fish mouth, fighting to breathe out of water, as the child breathed in and out. When all is back in place, they began the delicate work of stitching the skin back closed. The baby begins to stir, and the anesthesiologist works quickly to administer more drugs to lull it back into deep sleep, safe from the fear and pain that would be felt upon waking in such a situation. Soon the stitching is finished, the artificial airway removed, and the procedure comes to an end, two and a half hours later. I was amused to find the mood of the operating theatre is not so different from home; the surgeons and anesthesiologists have a similar quirky culture, though never disrespectful or undignified. I think it's necessary at some level to be able to perform this type of work.

Apart from the operating room, I spend most of my time on the adult surgical ward. Here I find myself emotionally drained by the large amount of wounds and injuries, and miniscule amount of supplies and resources. I managed to keep myself together for the most part, until Charles. I was in the community on Wednesday, the day Montana witnessed this man being thrown out of the ward, though the staff denies that is what happened. Regardless of the truth, Montana described to me a scene that brought me to tears. Charles is a middle-aged man, with burns to his chest, neck, and arm. His dressings had gone neglected, to the point where he let off a foul odor and had a swarm of flies constantly around him. He was left to sleep outside, with no care, and no attendant. The fact that he was left untreated, with no family or friends, and ostracized, made my heart ache. I decided to do whatever we could to help his case.

On the ward the next day, I was pushy until one of the nurses agreed to attend to him if he had the supplies. Equipped with the list of things we needed, Montana and I dashed off to gather gauze, gloves, hydrogen peroxide, antibiotic ointment and bandages. I was overjoyed to find the nurse who promised to help us still on the ward when we returned; burns are one of the few injuries that make me queasy, and I was not looking forward to managing this dressing on our own. Together, the three of us changed his dressings, wearing double masks to tolerate the smell. The procedure was painful for him, and I hate doing these things without proper pain control, but it was better for him to be done than not. When it was finished, the smell was gone, and so were the flies, which still lingered around the discarded bandages. Once finished, Montana and I headed to the market to buy him a sleeping mat, sheets, a basin, some shoes, food, and other basic necessities. James donated some clothes, and we were delighted to see Charles’ in James trendy pants the next day.

We purchased enough supplies to ensure that his dressing would be done for the entire week; if it is kept clean, he should be able to go for a skin graft. He should have gone for the procedure sooner, but didn’t have money for the supplies needed. And I don’t even mean high tech operating supplies, I mean gauze and surgical gloves. Though we provided the supplies he needed for the dressing changes, it’s still difficult to get things done, and I find myself increasingly frustrated with the system. Sterile gauze cannot be purchased here, the night nurses are to sterilize gauze in the autoclave as part of their duty, and there never seems to be enough to go around, something out of our control. Though we are determined to ensure that he receives the care he deserves, I worry that once we leave he will go unnoticed and neglected once again. From what I understand he is a thief, which may be part of the reason he has received such sub par care. As I told the Dr. I was discussing his case with - who seemed greatly amused by the attention I’ve been paying Charles – It doesn’t matter about his past or what he’s done. Don't y'all love Jesus around here?! (Like most, I suppose they pick and chose the parts of the Bible that are convenient for us. I wished we could all pick the parts that involve kindness towards others). I assured her I will do whatever needs to be done to help him get the care he needs, but I know even that will not be enough. I missed this week on the ward, due to my illness, but I hope the other girls have been able to convince some of the staff to care for him. Tomorrow will be our last chance to help get him the care he needs. I haven’t been able to accomplish much this week due to feeling so poorly, but I was determined to make sure I can at least help this one man. However, I know that once we leave, there is little we can do to help him any further. The girls assured me to leave more money or supplies won't do much, that it's time to let it go...I know they are right, but this one is going to be hard to shake off my conscience.

Our work here has been eye opening, and I think we are all looking forward to the reprieve of safari that begins this weekend. The work itself is not necessarily taxing, but the constant battle against a system that doesn't work certainly is. More than once this week I've cried tears of frustration. Uganda is not the dry, wasted countries we often imagine in our minds when we hear the word "Africa"; it is lush, full of fertile land, minerals, resources. It has the potential to care for its people, but they languish in hospital beds, often without even enough government funding to provide them with gauze, never mind gloves, or medicine. I haven't the answer, and know I can only begin to find it through continuous reading and education. Even then, can books really save us from the bad guys? Apparently just this morning,
Paravet Training Paravet Training Paravet Training

Carrie and Dayna
the president of Uganda has changed the law yet again to allow himself to remain in position for life. Hear. Hear.

I will return to work in Canada with eagerness, and will feel amazement at the surplus of supplies so readily available. I look forward to the order, the protocol, the endless resources, the evidence based practice, the ethics committees, standards of practice, and family centred care. Though I am amazed at what the workers can manage to do here with so little, I will feel comforted to be back in the sterile halls of Saskatchewan hospitals, delighted to hear the shrill sound of call bells beckoning me to provide care that is a privilege for both the patient and myself, part of the symbiotic relationship that is nursing. Because make no mistake; illness doesn't seem fair, but I've learned that to be granted a bed in a Canadian hospital is a privilege beyond imagination. You cannot fathom the despair and hopelessness of some of the poor sick and injured in these hospitals; and this is only one small hospital in a very large, very unfair world. My preachy point for today is to beg you to please, please
Nutrition Education Day Nutrition Education Day Nutrition Education Day

Tenielle dishing it out
- never complain to your nurse or any health care workers about the conditions in the hospital you are in. There may be endless noises, and terrible food, but at least you aren't left to beg for it like Charles was when we found him. Find a better, healthier way to cope with the emotions that go along with being sick or bedridden than berating your health care team. Our health care system leaves much to be desired, but at least we aren't left to rot in the halls if we can't afford a few measly dollars for bandages.

Beginning this trip, I knew I wasn't coming to change the world, to save lives - those ideas are grandiose, naive. I finish my work at the hospital with regret at the work left unfinished, and with relief that I don't have to face that despair anymore. What have I learned? That the world really is a shit place, and we have to be content with the bits of light and good that we find, and cling to those like mad in order to maintain your sanity, to keep your head above the water and keep hoping one day we'll surface. I fiercely believe one day there will be peace and joy for all, whether in this world or another. It's that hope that fuels my positivity, and my positivity that fuels my entire way of living. I am a joyful person, in a tiny beautiful world surrounded by good loving people, that exists in a much larger and rougher world that we're trying to understand and be a part of. I understand it more now, as I do after any international trip, and part of it makes me want to bury my head in the sand, but mostly I am more aware of my greater responsibility on the world stage. And I hope we all are, anyone who is reading. If anything, I hope I can encourage you to never be afraid to reach out and help someone, even if it means stepping out of your comfort zone, becoming vulnerable, sacrificing something of yourself. When we give of ourselves, we grow infinitely beyond that small part we've lost, and understand love better. Once, at the Safeway, there was this old man at the store whom I could see needed help with his shopping, but I was in a rush with my own impending dinner party and guests, so I helped him find his orange juice but left him on his own after that - an incident that still haunts me now, three years later. These are the worst regrets I think we can make, not stopping to help when you know you can so easily give to someone what they need to feel better.

Now that I've confessed about the old man and his juice, maybe I will finally get some sleep at night ;-) I guess it's also important to remember to forgive ourselves, and accept occasional limitations. Limitation - now there's a word I hate!

Tomorrow we leave at 6:00am for Queen Elizabeth II national park. My fingers are double crossed for a leopard sighting!! We are all very excited, eager to get out of the city and into nature. One last night before some well earned fun.

Thanks as always for reading, and love to everyone at home,

Carrie Ann

Additional photos below
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12th April 2017
Montana, Carrie, Tenielle

Greetings from Uganda
Hey... check this out. Coming to a year now. Its from the Bunyaruguru orphanage visit

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