On Monday and Tuesday of this week, we participated in a community outreach clinic in Rushere, Uganda. Rushere is in SW Uganda, and is slightly up in the mountains. It is a very small town, about a 40 minute drive off of the paved road. Since it is so small, the options for accommodations were limited. Our team of 11 had 8 rooms. Only two rooms were doubles, the rest were singles. Madison and Savannah shared a single room. This had a bed that is sized somewhere between a single and a double in the US, but definitely small. Jake and Jared had a double and Jill and Jayne shared a double. The rest of us had single rooms. In our immediate family, I was the only room with a sink in the bathroom. The guest house was built in a square, and the small “court yard” was a local drinking hangout that usually had lively discussions until about 1-2am. We arrived on Sunday evening and were supposed to check out on Wednesday am to head home. We decided, as a team, that we would rather drive back late on Tuesday night than to spend an extra night there. We arrived home around 12:15 am, and had cookies, chips, and g-nuts, for dinner, on the ride home.
If you missed the previous blog about Rushere, please read it before you continue with this one. As promised in the other Rushere blog, I met a new friend named David. The team from River Point Church in Sugar Land, Tx had seen David while visiting homes in the Rushere area on Sunday. They had invited his mother to bring him to the clinic on Monday.
David is 9 months old, and his mom brought him to the clinic on Monday to be seen. He had been sick for several days and did not look well when he arrived. Jill attentively noticed his ill appearance and brought him to my station, cutting to the front of the line. David had a noticeable fever, he appeared dehydrated, his lungs sounded “junky” (like pneumonia) and he appeared anemic. I am still mastering the art of reading anemia in African kids, but I had John, one of the local doctors, confirm my suspicion. John agreed that David definitely needed to be admitted to the hospital, and probably needed a blood transfusion. Dr. John sent a nurse with our teammate David, little David, and his mother to the hospital. Our David paid his “entry fee”, our nurse explained the situation and the plan was for little David to be admitted to Dr. John. This hospital drop off occurred between 1pm and 2pm. When we completed our clinic and got back to town, we went to check on David. This was about 6:30-7:00pm. The nurses on duty really did not know where David was or what had happened to him. The log book just said his name and that he was given paracetamol (like Tylenol) and was told to come back on Saturday. This was a 9 month old that had set off my “sick kid radar” and was a slam dunk admission. I was concerned that he would not have lived if he had not come to the clinic that day. I asked if a malaria test was done, and no one knew. The lab tech was gone for the day. I asked if we could see if they paid for a lab test or x-ray, but the accounts person was gone for the day too. I asked if David had been seen by a doctor, but the only record of him being here was the log book that said the he was given paracetamol and sent to the EID (early infant diagnosis) ward for HIV testing. This was not even true, because we had given him the paracetamol bottle, before he left the clinic. I did find out that David had been seen by a clinical officer. This guy was not there any longer, but at my insistence he was called. Jill, the Kids, and the Donicas are my witnesses that the vein on the side of my head was standing out so far that I could barely hold the phone to my ear. This young man seemed to be unsure of what happened either, until I jumped squarely in the middle of him. I asked him if he had done a physical exam. His answer of “yes” was followed quickly by the question of why he could not tell that this kid was urgently sick. He suddenly remembered that he had done a malaria test and that it was “negative”. He planned on admitting the child for pneumonia, but sent him to EID to test for HIV and then the mom was supposed to bring him back. He guessed the mom had decided to go home. So after asking the question 5 times, with emphasis, to make sure he understood the question, he agreed with me that it did not matter if David was HIV + or -, he still needed urgent treatment, and because he sent him across the hospital campus for this test (which comes back in 3 weeks) this boy was at home and could be dead. In a classic understatement, he said “I should come up there”. I asked, again with vein on my head popping emphasis, “who is your boss”? After much persistence he finally told me. The nurse thought it would be a good idea to talk with Dr. John. She had just seen him walk by and I thought that was a great idea, as we had worked with him all day and he agreed with me that this kid was desperately ill. I talked with John on the phone, and in about 2 minutes he was standing in the outpatient area with me. I told him as much of the scenario as I knew. He got in the lab and found out that the malaria test was positive and the clinical officer had not checked a blood count to evaluate the anemia. After John, in a calmer voice than I had used, reminded the clinical officer of his “ball dropping”, Dr. John said one of the biggest understatements of all time. He looked the clinical officer right in the eye and said “so, next time you should probably do better”. I kid you not!
We were still fearful for David’s life. His mom was told to follow up in 5 days? We had to find him and bring him back. We could still freshly remember the girl in Kachungwa that we sent to the hospital that died before we could get there to check on her. We have seen how malaria + pneumonia+ young age + anemia = bad outcome. The power went out in Rushere about the same time that all of this was going on. I was really tired from the day’s clinic, and it seemed overwhelming to try to find David in the dark. I was tempted to say that we had done all that we could do, and if something bad happened it would be on the clinical officer’s conscience. BUT the kids, especially Jake, would not hear of it! We were going to find David before we had dinner or slept! So Dr. John and a nurse, that knew the area where David lives, jumped in the van with us and we headed out to find David. It was 8:30pm and REALLY dark in Rushere. We drove as far as we could on the road, then Dr. John and the nurse went back into the village with flashlights, and some time later, they emerged with David and his mother. This prompted me to say “Ameena”, in my best Ugandan accent.
We took David and Dr. John back to the hospital for his admission. David still looked sick but was not any worse than when I had seen him early in the day. We left to have a late dinner and get some sleep before our clinic on Tuesday morning.
This story doesn’t end here. On Tuesday morning, Jill made a trip from our clinic to the Rushere Hospital to take Juliet for admission. While she was there, Jill was going to check on David. The hospital staff informed her that over the last couple of hours, they had not been able to find David, and they wondered if his mother had taken him home. OMGoodness! When Jill came back and told me this information, I could not believe it. Was his mother that crazy? Was the hospital that inept? While those two questions were jousting in my mind, David’s mother showed up at our clinic, carrying David. It turns out, that after we took David back to the hospital the night before, the nurses tried several times to get an IV, but were unsuccessful. David had been receiving his malaria medicines and antibiotics by intramuscular injections. His mother walked all the way from town, out to our rural clinic, to seek out more care for David! My first thought was “Jennifer”. We were blessed to have a NICU nurse, Jennifer, working with us from the Sugar Land, Tx team. She starts IVs on kids the size of a soda can, surely she could whip one into David. David was definitely dehydrated, which made IV starts difficult.
Jennifer was initially unable to get an IV, so we decided to try to rehydrate David. Jared and Jayne took turns giving David ORS (oral rehydrating solution) by the dropper full.
They did this for about 5 hours. Occasionally we would try, unsuccessfully to get an IV. We probably stuck David 10 times, including me trying to get an external jugular IV. After all of this rehydration and IV attempting, I looked at David’s eyelid again. He seemed much less anemic than he had earlier in the day. I talked it over with Dr. John, and it was decided that since he looked better, we would take David back to the hospital for continued IM injections. I got word on Thursday morning that David was doing better and was allowed to go home with medicines to take by mouth!
|Sugar Land Texas team|
As I have thought about this whole scenario, surrounding David’s care, I am convinced that God is trying to teach me 2 things.
1.) He likes to use people that you might not suspect to accomplish his purposes. I truly believe that David is alive because our team joined the Sugar Land team in Rushere this week. But it was not the Board Certified Emergency Medicine doctor or the highly experienced and trained NICU nurse from the Houston area that saved David. It was a team of mostly non-medical Texans that walked door to door inviting people to the clinic. It was a caring Mzungu lady that noticed him looking ill, among the hundreds of other people there, and her bringing him to the front of the line. It was the insistence of a 16 year old young man, with a heart the size of Lake Victoria, that refused to let “give up” be an option. It was an 11 year old girl and a 12 year old boy that were persistent for hours on end that ultimately made the difference. I have no doubt that if I trotted 100 kids in front of Nurse Jennifer, she’d get an IV in 99 of them. I think God let Jennifer and I struggle that day to teach us who the Healer is.
2.) As much as we pursued David on Monday night and his mother pursued us on Tuesday morning, God pursues us even more! Even though it seemed that David’s mother didn’t want our “rescue”, we pursued her. Even though we don’t deserve any grace from God, He pursues us, trying to woo us into a relationship with him. He tracks us past where the road ends. He hunts us down in the dark back alleys. He wants to give us a ride back to a place where healing occurs.
Thank you to the heroes on my Due Unto Others team. You continue to make a difference. Thank you to Jennifer for your persistence and patience in caring for David. Thank you to Dr. John for caring for David in the hospital. Thank you to the Sugar Land team for making home visits to invite David to the clinic. Thank you to the Holy Spirit for tapping me on the shoulder and teaching me the Truth!