Week 3 and 4

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Week three and four have come and gone. This blog post will encompass the past two weeks as we have fallen a wee bit behind on our entries. (Let’s blame this on the fact that we’ve been having too much fun.) We had a number of new experiences in the health centre including time in the operating room assisting to care for newly born c-sectioned babies, hosting immunization clinics, dispensing medication in the pharmacy, performing assessments in the out patient department, and making ward rounds. We spent Saturday, June 10 lounging by the pool at Kyengabi Crater Resort while enjoying western food. Sunday, June 11 called for a visit to The Cave; a local ecological tourist attraction. Here, we hiked and viewed "Dave's Cave" then toured the cultural museum onsite where we learned about historical African life and the tools used to grow the community and cultivate the land.

Our afternoons continue to be dedicated to our community initiatives. Philomena and Tye are placed in the Nyekega community while Rene and Vivian are working in Buheera Central. Both communities are a short walk from the Rugazi Health Centre. We spent the first 2 weeks assessing the communities' needs in order to plan our initiative. We work alongside the Ugandan students finding that the people in our communities look forward to our daily visits. The children often spend the afternoon following us from household to household patiently waiting to receive a sticker from one of us muzungus. After extensive community assessment both groups have deduced that dirty drinking water is a major problem in our communities. Our afternoons now focus on planning interventions that will simplify the process of boiling water along with health education as to why it is important to drink clean water.

We caution you as what you are about to read is an emotionally challenging story. The following event was experienced and is written by Tye and Rene (June 14):

We began our morning on the maternity ward and were soon scrubbing into the operating room to assist in receiving a baby to be born via c-section. We are both experienced in the OR and have participated in a number of caesarian sections. Mom was opened and baby came out with large amounts of meconium and the umbilical cord wrapped around her neck. We received the newborn baby omishiki (girl) along with a Ugandan nurse and quickly realized that this was not a healthy baby. She wasn't crying and showed visible signs of distressed breathing along with a slow heart rate. We began bulb suctioning and ventilating the baby and she began to whimper and move her limbs; albeit we could not get her to cry. The anesthesiologist soon came to assist in our efforts of helping the babe. We gave Dextrose 50 via the umbilical cord (which Tye ran to get from the maternity ward), atropine from the disorganized anesthesia cart, and the bulb suction was lost leading to a sprint from Rene to the maternity ward only to realize the entire hospital has only one bulb suction. This was followed by the anesthesiologist wanting to intubate to no aveil as the batteries were dead on the laryngoscope. Ventilation continued and baby's heart rate strengthened. As Rene carried the baby to the maternity ward the Ugandan nurse followed with the only oxygen concentrator in the facility, which was taken from the surgical mom. Babe was placed on the cement counter, clearly still distressed, with Rene as the only respondent in a room full of nurses and midwives. She continued to provide oxygen and ventilation asking 3 different nurses to cannulate the baby, as the baby was not doing well. This request was met with no response. This being Rene's first experience caring for a distressed newborn she felt alone and fearful as the experienced Ugandan nurse left her high and dry. Doing the best she could with the resources she had she persisted in her efforts. In comes Tye in the superman cape. Just kidding- she was also flying by the seat of her pants. Still our work was not done. Rene sent Tye to find our only trusted companion, fellow Ugandan nursing student Dominic Komakech Abok. After literally running to all of the hospital wards she found him in the last place she thought to look. The two returned to Rene in hopes of starting an IV. We were pleasantly surprised to find a nurse attempting to cannulate the baby and the return of the anesthesiologist. Again, wanting to intubate the baby he openly discussed the need for “AAA batteries” followed by, “this is African health care.” We both brought copious amounts of batteries and knew that we had AAA’s so one ran for the batteries and one ran for the scope. Yes, we definitely got our workout in for the day. It turns out the scope uses C batteries; the one type of battery we didn’t bring.

At this point, all but ourselves gave up hope and one nurse said to us, “You Canadians are so hopeful. We Africans would have given up long ago.” Left on the counter, barely wrapped laid a dying baby flanked by Rene, Tye and our friend Komakech knowing in our hearts that continuing to care for this baby was the right thing to do. Throughout the last 60 minutes we made many attempts to update mom about her daughter’s status. We were met with discouragement and resistance by health centre staff as we were told mom was in no state to receive the news and it was made very clear that we were not to talk to the mother. Taking the time to nicely wrap the baby and admiring the beauty of her freckles we couldn’t help but shed tears. She was an omishiki African baby and she died in our arms at 1145 on June 14, 2017.

Shortly thereafter we were informed of the situation leading to the caesarian. Mom had been laboring since Saturday, June 10 and refused caesarian on Sunday (for unknown reason) when labour was not progressing. She remained on the unit and was finally convinced to undergo c-section Wednesday morning.

That evening we returned to the unit with a hand-coloured portrait from Rene’s anti-stress colouring book with the baby’s birth details and our words of condolences. Although mom could not verbally express her thanks her eyes spoke volumes in thank yous to the two Canadian nurses who put all of their efforts into saving her baby girl.

Rene:

Since our last post, we have met some challenges and rewards. From resort hopping on our weekends enjoying beautiful African scenery; to hands on in the health centre immunizing almost 100 babies in just 2 hours, its most definitely been an experience. We have pushed our boundaries and enjoyed some road side foods – fried goat, chips with a delicious meat sauce (fries), fish, banana pancakes, and some fried root thing - all of which I greatly enjoyed (except the root thing, just was not for me).

This past Tuesday I assisted Tye in teaching a group of students about Canada, with my First Nations background guiding my section of the lecture. I was excited to share my culture, but fearful of how it would be received. Africa has come to learn that most “Red Indians” (First Nations) no longer exist. So, I was not sure how they would take my information of us existing. It was received with shock and amazement, or at least that’s how I received their response. And I felt proud that I could share my people’s history with a culture so rich in its own culture. I shared what little words I could with them in Cree, “Tansi” and “Meegwitch” each meaning hello and thank you, respectively. But what this group of kids did for me was something I did not see coming, they brought me to tears as they sang for us the national anthem of Uganda. The harmonized child voices brought happiness and honour to my heart in how they chose to share such beauty with us. To conclude our teachings, we recapped how Tye’s people colonized Rene’s people, but now we as a country are slowing working towards reconciliation. It may not be so visible, but this generation is living proof that many peoples can come to work together.

From tears on Tuesday to a separate set of tears on Wednesday, this week might have been the hardest it has been yet here in Rugazi. As you heard the story of my and Tye’s sad baby loss, it wretch my heart strings to see so little care being given. After reflecting we became grateful to be apart of it, although in the moment it wasn’t easy. We were grateful for the little love and warmth this baby omoshikki could have felt from us two muzocoo’s. But also, we received a glimpse into the gender culture present in this country, boys are just more a favourable sex. As throughout our life saving measures I must have been asked 3 separate times what the sex of the baby was, with a response of this baby was an omosho, I wonder if more attempts be made. Knowing there is nothing I can do to control this situation (it is out of my sphere of control) I will look at it to reflect on my life, where I can improve, and just how it can relate to my practice when I return home. Because out of all experience, lessons can be learned.

I was excited as we went on a group outing with Ugandan mates, we visited “The Cave”. It’s a small little cave, sitting beside a crater lake hidden away in a tiny nook. The history of how local people would hide in there in the rule Iddi Amin and in the time of NRA (National Resistance Army). Men would seek refuge in the cave during these times, and come out at night to return to their families. After the cave, we were shown a cultural museum, sharing some ancient tools that used to be used from local people. Some are still used today. Culture is very important for me and I came here most to see the culture present; so, going on this outing was greatly enjoyable and even more so to have our Ugandan friends by our side.

To end my section this week, I will update that I have had locally made coffee. Ironically it was made in the local community where we are doing our community project. Sadly, I had no French press, so I drank finely ground coffee beans in my milk tea. Although it was alright, the coffee grounds in my teeth afterwards were not so favourable. BUT, I have contacted the Canadian group in Ruhija who has informed me that that coffee there is superb! So you know where I be going before I head home to Canada….Ruhija area.

Phil:

The past week flew by for me! Highlights in the clinic were infant and toddler immunisations and dispensing medications for the Anti-Retroviral Therapy Clinic. Patients meet with a health professional for a brief assessment then receive doses of their medication free of charge for one, two, or three months depending on their specific situation. I was happy to learn that the drugs given for first line HIV/AIDS treatment are manufactured in Uganda. I also learned from one of the Ugandan students that it is illegal to sell tuberculosis medication. The government of Uganda purchases the medication to be distributed freely and wants to monitor dispensing in order to keep track of infection and treatment in the country.

In the community where Tye and I are placed, we finished with home visits this week. Through conversations with community members in their homes, our group has identified safe drinking water as a key issue. I was touched by moments of hospitality by community members this week. One individual gave our group some avocados from his tree. Catching them was a challenge, but they were delicious with our dinner yesterday! A member of the village health team invited us to her home. We enjoyed fresh mangoes and refreshing homemade pineapple-passion fruit juice while poring over family photos and hearing about her life hopes, goals, and accomplishments.

Situations this week have taught me the importance of not only asking questions but asking the same questions to different people. Doing this allowed me to better understand cultural differences at the health center and within our group.

Tye:

In reflecting on our difficult day with the baby girl and her mother my first thought is how thankful I am to have nursed alongside Rene. We were teammates from start to finish and I felt supported. She is a wonderful nurse and a wonderful friend.

I also realize that we were this baby’s best chance of survival. The outcome is a parents’ worst nightmare but I hope the mom felt respected, cared for and acknowledged by the two of us. I was challenged in a multitude of ways but the biggest hurdle I faced was the ethical dilemma of withholding information from the mom. The mother was never asked about her wishes and she never got to hold her daughter alive, despite our best efforts at telling the staff that we would like to involve the mother. We were posed with a cultural and health standard barrier that, unfortunately, we could not breach.

Strength rises from darkness. I am proud to be a registered nurse and although today was difficult I will return tomorrow as a more compassionate, empathetic, and competent practitioner thanks to our little freckled omoshiki.

I visited the school on Monday, June 12 teaching the students about contraceptive methods or “family planning” as it is referred to in Uganda. The students had a good giggle at me teaching them to use condoms, male and female, the later of which I had to learn myself prior to the lesson. Rene has already bragged about our Canadian lesson at the school, which was a great success. The kids enjoyed a balloon game, Indigenous teaching, our national anthem, and a geography lesson using a hand drawn map outlining our 13 provinces and territories. I am SO proud to be Canadian.

I took a tumble while running on Thursday. This is only my second fall since being in Uganda which is actually quite remarkable for me. As though running through town as a white person isn't a spectacle in itself, I returned home covered in dirt and blood. My scabs are healing nicely and I have since resumed my daily morning jogs.

The highlight of my week in the clinic came on Frida, June 16 when 3 nurses, including myself, registered and immunized over 100 babies. I made every single one of them cry but for darn good reason! No polio, measles, tuberculosis, of diptheria for these Ugandan babes.

My Canadian girls along with the Ugandan students made me feel very special on June 17, celebrating my 23 birthday. They bought me a cake, made me a card, and we visited the Baboon Safari Resort in the afternoon where we enjoyed the poolside, western food, pineapple juice with Malibu, and my favourite- an outdoor shower in the rain forest. The power and water both shut off for the majority of the day but this didn’t dampen our mood. I ended the day reading numerous birthday cards sent by friends and family with a flashlight under the stars.

Vivian:

The great thing about this blog is that our different experiences each week are brought here together. This past week for me has flashed by so quickly. I spent some time in the immunization clinic with Phil and Tye which was very busy. What I enjoyed the most about working in this community is being able to speak my native language and engage in my culture and way of life. Living in Canada as a Ugandan immigrant can be lonely because there isn't a prominent Ugandan community and so, being able to immerse myself in my own culture while working with clients has been extremely humbling. It makes me appreciate the value of community and culture. On the side note, over the weekend, I traveled back to Kampala to attend a cousin's traditional wedding. There, I met a large portion of my extended family which was amazing. I was overwhelmed by the customs and traditions that take place when a woman is being introduced to her future husband. I have a deep appreciation for my culture and my mother always jokes that my future husband (wherever he comes from) will have to honour my customs and traditions when asking for my hand in marriage. Over the weekend I attended a rapid roasting session that is a tradition at the Ugandan wedding, called a "Kuhingira." This follows the giving away of the bride, where the prospective husband visits the bride-to-be's family and begs for her hand in marriage. The Kuhingira is followed by a white wedding.

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