Covenant

"God continued, 'This is the sign of the covenant I am making between me and you and everything living around you and everyone living after you. I'm putting my rainbow in the clouds, a sign of the covenant between me and the Earth. From now on, when I form a cloud over the Earth and the rainbow appears in the cloud, I'll remember my covenant between me and you and everything living, that never again will floodwaters destroy all life. When the rainbow appears in the cloud, I'll see it and remember the eternal covenant between God and everything living, every last living creature on Earth.' And God said, 'This is the sign of the covenant that I've set up between me and everything living on the Earth.'" - Gen 9: 8-17 (The Message)

This is falls #3 from our 3 falls hike at Sipi. When I crested the hill that obstructed the view of the bottom of these falls, tears welled up in my eyes. The combination of the image of God's covenant in the rainbow combined with the steadfast rocks under the violent and forceful water was like a gift from God direct to me at that moment. Our guide was antsy to get back before the afternoon rain came, so we didn't stay long, but a glimpse was all I needed!

feeling disconnected?

Make some cookies...I'm pretty sure that making cookies could probably solve most of the world's problems. It occurred to me just after writing the last post, that what I should do about feeling disconnected is to take a few steps towards connecting...you know how when you feel disconnected you don't really feel up to connecting? Well, that's where making cookies comes in and saves the day...so I got out the monstrous bag of chocolate chips that mom and dad brought me (thanks guys!), cut the flour by 1/4 cup, split the butter asked for with half shortening (to conserve on butter which is in short supply), took them out of the oven a few minutes before they were due, and took a plate full of hot cookies to the girls' house and to Nathan...I didn't even have to say more than "I made you some cookies" but it communicated much more (I think...I hope...maybe I was the only one benefiting from the communication, but it worked for me!). Now, it, of course, is also very possible that the several cookies worth of dough that I snitched along the way went a long way in curing my disconnection...the wonders of chocolate :)

randomness

• from a child's admission sheet under the "history and complaints" section:
  

"febrile ass with cough" heh heh heh :)

• The treatment room is a smallish room with a set of windows, a bed, a bench, and a set of shelves...otherwise empty unless patients are lined up on the bench waiting for IV placements or blood draws. Yesterday I stood next to the bed on which lay the body of a toddler whose life had just ceased and was overwhelmed by the deafening bone chilling reverberations of women wailing in the small room...I could literally feel their grief rattling my bones.

• "Those look like my sandals" I thought to myself. I was leaning against the nurses' desk as Jennifer went through her morning routine of telling everyone to get their paperwork out along with all of their medicines in preparation for rounds. My eyes were scanning the floor in the center pod, avoiding the stares of all of the parents, looking at the seguilis and basins stashed under the beds, at the jolo-jolos (flip flops) taken off beside the mats used for sitting and eating next to the beds, and then past a set of male feet next to one of the nearest beds...it was after those feet that I did the double take, looking up at him, finding him staring back and me, then glancing down again to his feet...dusty black leather straps that wrap around the big toe, cork foot beds with black rubber soles...I grinned to myself and after Jennifer had finished told her "The sandals that guy is wearing look like one of the pairs of shoes that were stolen from my house." She looked back at me to see if I was serious..."really?!" she said. "Yep" I confirmed. She looked at the shoes and said "they look like Birkenstocks." "yeah, but they're not, they're Naots, I bought them in Israel when I studied abroad there in 2000." She looked up at the man who was understanding our English and stated that he bought them in Fort Portal at Mpanga market...he was dressed like someone who would have the means to make such a trip and I believed his story. "Can I see the bottom of the shoe?" Jennifer asked and he showed her...looking at the side of the sole she read, "It says N-A-O-T?" she read looking to me for confirmation..."Yep, it's them." I confirmed. "These shoes were stolen from her house a few months ago" Jennifer reported. "EH?! Foh shuah?" he exclaimed. "It's okay," I said, "I'm glad you're enjoying them. They're good shoes. I bought them in the year 2000." "Eh? And it's now 2009" he pointed out. I smiled and nodded. What in the world is the likelihood that one of my all time favorite pairs of sandals I bought in Israel 9 years ago would be stolen, taken to Fort Portal (a 3 hour trip from here), sold in the big market there to someone who lives in Bundibugyo and wore them to Nyahuka Health Center? Craziness. We laughed. It's good to start the day with a good laugh.
• I don't think I ever mentioned that the day after my return to Bundibugyo after 3 weeks of travel/R&R, a snake was killed in my house...about the diameter of a quarter and black he slithered into my house before the door closed after I brought my laundry out back for washing by Asita...I turned around and saw him go into the house and yelled...Asita looked at me to see what it was I was making a commotion about, and she began to yell as well. Pat heard me too and came to see...Pat and Asita used sticks and rocks to bring him to his death just inside the back door of my house as I stood by and watched...good thing he didn't decide to show his slimy self while my mom was around :)
• I love rainy season...the cool that the rain brings to an afternoon or evening as it blows in, the way you can often hear the rain coming as it falls on the tin roofs closer and closer to where you are, the incredible clarity with which we can see the mountains most mornings after rain the night/evening before, the quieting of knocks at the front door when it's raining, falling asleep to the drone of the rain falling on the roof, and of course the changes in barometric pressure that Pat is sure causes her to sweat at random times throughout the evening :)
• I love it that my brother will tell me "Heidi, that sounds like a hellacious idea!" after mentioning to him something I am thinking about...he's probably the only person on the face of the earth who will say such a thing to me, but I love it! I need that in my life! (Okay, so I'm maybe not so excited at the exact moment when that comes out of his mouth and makes its way across the phone lines and over oceans from thousands of miles away, but a few moments later I smile to myself, and think "Webaleh Jeff!")
• I don't love hard copy record keeping and the disaster of budgeting that ensues in BundiNutrition.
• I watched Changeling the other night and was very well disturbed. Watched Vicky Christina Barcelona last night and was challenged and both discouraged and encouraged at the same time.
• I am feeling quite detached from everyone and everything in my life right now. It's not a sentiment I would recommend. Not quite sure what to do about it.
  

8E shoutout

Hey ladies. Have, in the last few days, been "friended" by a few of you on facebook which gives me hope that you haven't disowned me for my lack of communication :P Lack of communication does NOT equal lack of thought! In fact early this week I thought about all of you a lot. Let me tell you a little story...

Biira was a 3 or 4 year old girl, a bit older than most of the kids we see with malnutrition...developmentally delayed, she says "mama" and that's about it, came in with LE swelling, skin peeling, mouth cracked in the corners, typical presentation of Kwashiorkor. She never smiled, always irritable. She was started on F75, the starter formula for severe acute malnutrition supplied to us by UNICEF, and she began to loose weight. We actually like for this to happen with Kwashiorkor kids because their weight should drop as they loose their edema and then they turn the corner after a week or two and begin to gain "good" weight (without edema). Anyways, for the first week she continued to loose weight, the second week we moved her up to the "maintenance" formula, F100 (higher caloric density) - she continued to loose weight. Knowing that it takes some kids more time to turn the corner than others, we continued to support her with various treatments for her diarrhea including vitamin enriched oral rehydration solution for severely malnourished kids. She kept taking the milk, and kept loosing weight. Into her 4th week she was beginning to waste away after making a brief improvement late in the 3rd week...Friday when I left she had IVF going through a scalp IV that the supervising nursing officer placed and I didn't think I was going to see her Monday morning when I came back.

Monday morning her mom had packed all of their things up, and Biira was lying on the bed wrapped in a kitenge unconscious and walking that precipice between life and death...Jennifer and I were alone on the ward without any Ugandan staff. We looked at each other, each took a deep breath, she put her pen to the page and I reached for another bottle of IVF. Now, none of my 8E coworkers will be shocked to learn that I was quite relieved to see that the scalp IV Mr. Mwonge had placed on Friday was still there. I strung the IVF and drew up some saline to flush the line before starting the fluids...*#$@! It was swelling when flushed - ie. the IV was no good; there but not really there. Remember how I said we were alone on the ward without any Ugandan staff? You know what that means..."Heidi, you're the one!" I thought to myself. I gathered all of my supplies, hoping that someone would miraculously appear by the time I got it all together...nope. Well, there clearly must be another solution...so I went searching for another nurse. I searched in vain. The only one around was Mr. Mwonge stumbling out of his house on his way to the cho...I clearly was not going to interrupt him. So back to the ward I went, steeling myself for facing the challenge awaiting me in the treatment room...a 4 year old very dark skinned little girl who has had diarrhea for weeks in need of an IV..."There are no IV teams, Heidi, no transport teams, no NICU nurses, no no one...you're it. She's going to die if you don't do anything (and still probably will die even if we do, but that doesn't stop us)" (all of this of course swirling around in my head in a matter of seconds...)

So, I rip off the curled hem of a glove before putting it on, tied this rubber band "tourniquet" around Biira's wrist...nothing...the other wrist...nothing...gently slapping her hands, trying to make a shadow of even the smallest vein pop up...nothing...trying to reposition her and myself around the bed so that I could get the best light from the open window...both feet...nothing...so I put it around her head and there was one...nope, look closely, it's pulsing...that's an artery...no go...I tried 3 times, trying to leave room lower for someone else to try when all I got was a quick flashback and then each would blow...I kept looking...from one side of her scalp to the other...and that's when I heard Asussi's voice...ah! another nurse...praise God! She tried a few times, and couldn't find anything either...Mr. Mwonge came eventually and tried without success...Even NGT placement was not successful, kept coiling inside her mouth...no ice to try to stiffen the tube with...what to do? How to hydrate this child?

Asussi recommended the mom heat some water and we would fill a few gloves with water and place them around Biira as she lay in bed, to try to create some vasodilation to ease IV placement...the family complied immediately. When I left for the day there were 3 experienced nurses around and Biira was warming up.

Tuesday morning the night report said she was finishing her IVF, and there was the bag hanging...Agnes had successfully placed an EJ...you gotta do what you gotta do...We were a half hour or so through rounds and I heard a mother begin to cry..."uh oh" I thought to myself...Jennifer looked up from the patient she was seeing and a crowd was begining to form around Biira's bed. We went over and found an aunt or grandmother closing Biira's eyelids, as Biira's mom cried with her hands over her face...Jennifer put her stethescope to Biira's chest...nothing...the crying grew louder...I handed Kasareka, who was already gloved, a stack of 4x4 gauze for tying her chin closed and wrists/ankles...the crowd grew around the bed....as they got things packed up, mom was helped out to the front porch of the ward. I glanced up from the patient we had returned to seeing and the mom's tears had grown to full blown wailing and she was writhing on the floor in mourning, with other women trying to help her up to no avail...I took several deep breaths, accompanied by heavy sighs.

So, even though we finally got a line, we could do nothing to stop this little one from drifting off...but just goes to show you that not much has changed...I'm still a wuss when it comes to putting IV's in...it's not for lack of knowledge, just lack of courage...poking children when there are people around who are better skilled seems cruel, but what has that led to? No skilled experience base when there is no else around...This place doesn't so much allow for lack of courage...I keep telling myself one of these days I just need to take a whole week and be the go-to for IV placement and blood draws...practice makes perfect (although I'm sure none of you non-nurses like to hear that - it's for sure the truth). So, thanks to all of you who saved my rear countless times on 8E with putting in lines/drawing blood, and thanks to all of you who made me do it myself (BW, BM, MK, MH, LH). I miss you guys so much!

everyone sitting down?

...you'll never believe this...I voluntarily got out of bed at 6:15am this morning and went on a walk with Pat! Sooooooooo nice. If only getting out of bed were not my least favorite part of the day...we definitely need to do this more often. Only curteous and friendly people are on the road at that time of day evidently, AND we were rewarded as we headed back towards the mission with an absolutely stunning view of the pink/purple rays of the morning sun cast atop the Rwenzori mountains! Then as we rounded the next bend, the light had changed and the mountains again were shadowed...what a glimpse of glory!

frailty and boldness

I just started reading Mountains Beyond Mountains last night after picking it up from the Bundibugyo Library - Chez Myhre Branch. "GASP!" I can just hear the collective gasps now going on around the world as you all read..."Heidi's never read Mountains Beyond Mountains?! Travesty!" And you would be right, it's been a long time comin'. In any case, I am reading it now, so you can all get back on your chairs and rest assured that I have not in fact lost all connection to the rest of the world, I'm just several years behind, not much is new there!

Anyways, only 2 chapters in but I'm already enjoying it. Humor me while I share a bit of what makes me tick...I've recently told you about my fondness of the city, here's another snapshot into my affinities...this is a bit from the above mentioned book that so articulately describes some of of what I love about health care. PS (pre-script) - Now, all of you out there who I have disagreed with about medicine and it's importance or lack thereof, other medical topics of various kinds, bear with me, give me some grace and the benefit of the doubt for this once and just read :)

"Outside the Brigham and Women's Hospital in Boston, you're aware of a relative urban quiet. A Wall Street of medicine surrounds you: the campus of Harvard Medical School and the Countway Medical Library, Children's Hospital, Beth Israel Deaconess, Dana-Farber Cancer Institute, the Brigham. The buildings look imposing packed together, and even awesome when you let yourself imagine what's going on inside. Chest crackings, organ transplants, molecular imagings, genetic probes - gloved hands and machines routinely reaching into bodies and making diagnoses and corrections, so much of human frailty on the one hand and boldness on the other. One feels stilled in the presence of this enterprise. Even the Boston drivers, famously deranged, don't honk much when passing through the neighborhood." - Tracey Kidder (Mountains Beyond Mountains)

"so much frailty on the one hand and boldness on the other"...whether you're at the Brigham and Women's Hospital in Boston or Nyahuka Health Center IV in Bundibugyo, Uganda, some things are the same the world round...unfortunately the "famously deranged" drivers of Nyahuka don't have the same sort of reverence for NHC IV as they do in Boston for those imposing institutions...(you'd be hard pressed to describe NHC IV as imposing!). Whether Boston or Nyahuka, you have to pause every now and again to marvel at what it is that's going on around and through you...successes and failures...frailty and boldness are in it all.

Sipi

After leaving Bundibugyo, and before heading to Nairobi, the Lutjens 3 headed east through Mbale to Sipi Falls, near Mt. Elgon and the Kenya border. I had never been east of Jinja before this trip, so it was really fun to see a new part of the country and how different it was from the west. My mom remarked, as we drove through the low lying rice fields, how it's amazing that in such a small country we were able to see such diverse terrain. Here we are, smiles and all!
The day after our evening arrival, we headed off on a day hike to the 3 falls in the area, first to the bottom of Sipi (pictured here in pretty close to it's entirety)...

"Let the words of my mouth and the meditations of my heart be pleasing in your sight, my ROCK, and my Redeemer." Psalm 19:14
"The Rock" - my favorite part of waterfalls are the base of the falls, where the water hits whatever is below. I was really struck by this image as I stood there watching and listening to the thundering water against these rocks. I left Bundibugyo and arrived at Sipi in a pretty hard place in life, and the image of the solidarity of this rock in the thundering and crashing water was just what I needed. My dad read Psalm 19 before we all went to bed at the end of the day of hiking, and my mind took hold of the last verse (14).
...back to the hike...note the banana trees...just a very different kind of hiking than I grew up with...different but just as beautiful!
The hike to the base of Sipi involved a descent and then this ascent of the pictured ladder.
Falls #2 - after Sipi we hiked to these falls where we stopped for lunch.
A shot of Sipi from the top, from the lodge we stayed in. The grassy clearing just to the left of the top of the falls has a few people standing in it...one of them is me preparing to abseil down the falls. Abseiling is like repelling I guess. Your rope is anchored into the rock at the top, you're secured into a harness, you face the rock, you put your feet on the edge and sit back into the harness, and begin walking down, then the rock disappears and you're hanging freely from the rope, and you feed the rope, which is hanging down at your side reaching the bottom of the falls, through the 8 hook next to your harness and slowly by slowly you move down the rope...I was definitely moving slowly but I was in no hurry!
I'm not sure if you can see it, but if you follow the middle dark "finger" in the rock down, there's light colored rock and then a more circular dark spot which is about 1/2 way down the photo, and in the middle of that dark spot, there's a white speck...that's me :) It was one of the most exhiarating experiences of my life...suspended by a rope in front of the thundering falls...amazing.
This is the view of the valley from our lodge
And our dinner with a view. Spectacular spot.